甲状腺癌诊断中FNAC假阴性结果影响因素的分析

The value of FNAC in diagnosis of thyroid carcinoma and the analysis of false negative factors

目的探讨容易导致细针穿刺细胞学(FNAC)假阴性结果的危险因素并评估FNAC在甲状腺癌诊断上的价值。方法回顾性分析2014年10月-2015年10月间,对甲状腺结节患者行FNAC,并于吉大一院甲状腺外科住院行手术治疗的612例患者资料。所有患者术前均行超声、实验室检查等常规检查,术中均行冰冻切片病理,术后行石蜡病理检查。对其中27例FNAC假阴性和36例FNAC真阴性两组患者的结节大小(≤0.5cm或者>0.5cm)、合并桥本氏甲状腺炎、多病灶、超声提示钙化、合并甲亢、TSH、FT3、FT4以及心率值行对比分析。结果两组比较结节大小、多病灶、合并桥本以及超声提示钙化,P值<0.05,有统计学差异。而合并甲亢、术前TSH、FT3、FT4以及心率,P值>0.05,无统计学差异。结论 (1)结节直径≤0.5cm、多病灶、合并桥本以及超声提示钙化,容易导致FNAC假阴性结果。(2)结节直径>0.5cm以及合并甲亢不会增加FNAC假阴性几率且假阴性结果与患者心率以及术前的TSH、FT3、FT4值无关。

Objective The aim of study is to review the independent risk factors of fine needle aspiration cytology false-negative results and assess the value of fine needle aspiration cytology in the diagnosis of thyroid cancer. Methods A retrospective analysis from October 2014 to October 2015 period,612 eases of patients all have the FNAC results which puncture by the same sonographer and the same cytology examining physician,and all treated at the Department of Thyroid Surgery,the First Hospital of the Jilin University, Changchun,China. All patients have been prepared for Ultrasound examination,laboratory tests and other routine examinations preoperative and have the results of FNAC,intraoperative frozen section examination and postoperative pathology. Comparing 27 false-negative patients to 36 truenegative patients in two groups analyzing the factors of nodule size （≤0.5 cm or 〉0.5 cm）, multiple centers, cancer with Hashimoto＇s thyroiditis, cancer with hyperthyroidism, ultrasound calcification, TSH, FT3, FT4 and heart rate. Results Nodules ≤0.5 cm,multiple centers, cancer with Hashimoto＇s thyroiditis and ultrasound calcification,P〈0.05 ,are easily lead to the false negative results with statistically significant. Cancer with hyperthyroidism, the value of TSH, FT3,FT4 preoperative and heart rate,P〉0.05, there is no significantly difference. Conclusion （1）Nodules≤0.5 cm, multiple centers,cancer with Hashimoto＇s thyroiditis and ultrasound calcification are easily lead to the false negative results. （2）Nodules〉0.5 cm and cancer with hyperthyroidism aren＇t the independent risk factors of false negative results. The false negative result is irrelevant to the value of TSH,FT3,FT4 preoperative and heart rate.