甲状腺结节超声引导下细针穿刺无效的图像特征探讨

Ultrasonographic findings affecting inefficiency of ultrasound-guided fine-needle aspiration biopsy for thyroid nodules

目的探讨甲状腺结节超声引导细针穿刺(US-FNAB)无效的相关超声图像特征。方法回顾分析2011年3月~2012年5月行US-FNAB的200例甲状腺结节,参照细胞病理学Bethesda标准,将穿刺结果分为穿刺无效和穿刺有效两类,分析其超声图像特征与穿刺无效的关系。结果影响甲状腺结节US-FNAB穿刺无效率的超声特征包括:伴有粗大钙化的结节(P=0.018)、血流丰富的结节(P=0.029)、血流环绕结节的外周分布(P=0.004)、位置较深的结节(P=0.038)、结节邻近重要结构(P<0.001)、穿刺前超声诊断良性的结节(P=0.04)、伴有亚急性甲状腺炎背景的结节(P=0.029)和最大径线<10mm的结节(P=0.013)。结论了解容易导致甲状腺结节US-FNAB穿刺无效的超声图像特征,是加强针对性训练和提高穿刺水平的重要环节。

Objective To evaluate the ultrasonographic features of thyroid nodules related to inefficient operations of ultrasound-guided fine-needle aspiration（US-FNAB）.Methods The ultrasonographic features and cytopathology results after US-FNAB of 200 thyroid nodules from March 2011 to May 2012 were retrospectively analyzed.Based on the cytopathology results guided by Bethesda system,the operations of US-FNAB with satisfactory and unsatisfactory samples were defined as efficient and inefficient respectively.The relationship between ultrasonographic features and inefficient operations were assessed.Results The ultrasonographic features significantly related to inefficient operations were macrocalcification（P=0.018）,rich inner blood flow（P=0.029）,surrounding blood flow（P=0.004）,deep location（P=0.038）,peripheral vital structures（P〈0.001）,benign prediction by ultrasonography（P=0.04）,subacute thyroiditis background（P=0.029）and nodule size smaller than 10 mm（P=0.013）.Conclusion It is important to recognize the ultrasonographic features related to inefficient operations to make intensive training and achieve efficient operation in USFNAB of thyroid nodules.