甲状腺癌的临床病理特点及细针穿刺活检技术的临床诊断价值

Analysis of the clinicopathological characteristics and the clinical value of fine-needle aspiration biopsy for thyroid carcinoma

目的研究甲状腺癌(thyroid cancer,TC)与甲状腺良性结节手术病人的临床病理特点,探讨细针穿刺活检(fine needle aspiration biopsy,FNAB)对于甲状腺结节手术的指导意义。方法回顾性分析2918例甲状腺良恶性结节手术病人的临床病理资料。结果年龄<45岁病人在甲状腺良性结节组和TC组分别占26.23%和51.26%,两组间比较差异有统计学意义(P<0.05);男性病人在甲状腺良性结节组和TC组分别占比16.82%和20.15%,两组间比较差异有统计学意义(P<0.05);有甲状腺相关疾病家族史病人在甲状腺良性结节组和TC组分别占2.93%和3.70%,两组间比较差异无统计学意义(P<0.05);单发病灶病人在甲状腺良性结节组和TC组分别占40.42%和47.95%,两组间比较差异有统计学意义(P<0.05)。FNAB技术推广应用后,所有甲状腺结节手术病人中TC占比升高4.83%(P<0.05),结节病理肿块直径大小增大0.46 cm(P<0.01)。结论与甲状腺良性结节比较,TC具有发病年龄偏早、男性病人比例高、单发病灶常见的特点。TC甲状腺相关疾病家族史与甲状腺良性结节间比较,差异无统计学意义。FNAB技术的应用避免了部分甲状腺良性结节尤其是病理肿块直径较小的结节病人的过度手术,对于甲状腺结节性质的术前判断有重要意义。

Objective To analyze the clinicopathological characteristics of patients with benign thyroid nodules（BTN） and thyroid carcinoma（TC）,and explore the clinical value of fine-needle aspiration biopsy（FNAB） in diagnosis of TC.Methods A retrospective analysis was conducted on the data of 2918 cases with thyroid carcinoma,who underwent surgery in the People＇s Hospital of Wuhan University between January 2011 and February 2015.Results Patients aged younger than 45 years old accounted for26.23% and 51.26% in BTN group and CT group,respectively,and the difference between the two groups were statistically significant（P〈0.05）.Male patients accounted for 16.82% and 20.15% in BTN group and CT group,respectively,and the difference between the two groups were statistically significant（P〈0.05）.Patients with family history of thyroid related diseases accounted for 2.93% and 3.70% in BTN group and CT group,respectively,and there was no statistically significant difference between the two groups（P〈0.05）.Patients with solitary lesion accounted for 40.42% and 47.95% in BTN group and CT group,respectively,and the difference between the two groups were statistically significant（P〈0.05）.After the application of FNAB,the percentage of the patients diagnosed with TC was increased by 4.83%（P〈0.05）,and the diameter of nodular was increased by 4 cm（P〈0.01）.Conclusion Patients with TC have a characteristic of earlier onset age,higher proportion of male patients and lower incidence of multifocality compared with patients with BTN.There was no statistically significant difference between the TC group with family history of thyroid related diseases and the BTN group.The application of FNAB avoids of unnecessary surgeries on some BTN patients with small pathological diameter of nodule,it is important for preoperative diagnosis of thyroid nodules.