2386例甲状腺细针穿刺液基细胞学病理诊断分析

Characteristics of thyroid fine needle aspiration liquid-based cytology:pathological diagnosis of 2386 cases

目的探讨甲状腺结节细针穿刺(FNA)液基细胞学形态特征及诊断价值。方法超声引导下对2386例甲状腺结节行细针穿刺及液基细胞学检测。细胞学结果按甲状腺Bethesda系统报告。361例行手术切除并得组织学对照,分析液基细胞学形态特征及诊断敏感性、特异性、准确性、假阴性漏诊原因。结果 (1)2386例FNA诊断结果:Ⅰ类:标本无法诊断285例(11.9%);Ⅱ类:良性病变1128例(47.3%);Ⅲ类:意义不明确的非典型病变179例(7.5%);Ⅳ类:滤泡性肿瘤70例(2.9%);Ⅴ类:可疑恶性肿瘤188例(7.9%);Ⅵ类:恶性肿瘤536例(22.5%)。(2)361例FNAC对应的组织学结果:良性病变74例(20.5%),恶性肿瘤287例(占切除标本79.5%),细胞学阳性组(Ⅲ、Ⅴ、Ⅵ类)恶性肿瘤269例(96.1%)显著高于细胞学阴性组(Ⅰ、Ⅱ类)22.2%(16/72),二者差异显著(P<0.01);FNAC诊断敏感性94.4%、特异性83.6%、准确性92.3%,阳性预测值为96.1%,阴性预测值为83.3%。(3)肿瘤灶≤0.2 cm、纤维化、钙化、囊性变等因素导致未抽吸到肿瘤细胞是细胞学假阴性漏诊主要原因。结论超声引导下细针穿刺液基细胞学检测是甲状腺结节术前良恶性鉴别诊断的准确有效方法,可明显提高甲状腺结节术前诊断准确率。

Objective To summarize and analyze the morphological characteristics and diagnostic value of fine needle aspiration（ FNA） cytology in thyroid nodules. Methods A total of 2386 patients with thyroid nodules underwent fine needle aspiration and liquid-based cytology,and the cytological results were reported by thyroid Bethesda system. 361 patients that underwent surgical resection were reviewed and their cytological features and diagnostic parameters were analyzed. Results Among the 2386 FNAC cases,285 cases（ 11. 9%） could not be diagnosed and named as Class Ⅰ;1128 cases（ 47. 3%） were benign lesions,as Class Ⅱ; 179 cases（ 7. 5%） were atypical lesions,as Class Ⅲ; 70 cases（ 2. 9%） were follicular tumors,as Class IV; 188 cases（ 7. 9%） were suspicious malignant tumor,as Class Ⅴ; 536 cases（ 22. 5%） were malignant tumors,as Class Ⅵ. The histological findings of 361 cases by FNAC were benign lesions in 74 cases（ 20. 5%）,malignant tumors in 287 cases（ accounting for 79. 5% of resection specimens）. The incidence of malignant tumors in the cytology positive group（ Ⅲ,Ⅴ,Ⅵ） was 96. 1%（ 269/280）,significantly higher than that in the negative group（ class Ⅰ and class Ⅱ） which was 22. 2%（ 16/72）（ P 0. 01）. The sensitivity of FNAC was 94. 4% and the specificity was 83. 6%; the accuracy was 92. 3%,the positive predictive value was 96. 1%,and the negative predictive value was 83. 3%. The reasons to miss diagnosis in FNAC were tumor size ≤ 0. 2 cm,fibrosis,calcification,cystic degeneration and etc. Therefore,no tumor cells were pumped by FNAC leading to false negative in cytological test.Conclusion Ultrasound-guided fine-needle aspiration liquid-based cytology test is an accurate and effective method for the differential diagnosis of benign and malignant thyroid nodules,and it could significantly improve the accuracy of preoperative diagnosis of thyroid nodules.