粗针活检组织学与细针穿刺细胞学诊断甲状腺恶性结节的比较研究

Core-needle biopsy histology vs fine needle aspiration cytology for the diagnosis of malignant thyroid nodules: a comparative study

目的回顾性分析比较超声引导下粗针活检组织学(CNB)及细针穿刺细胞学(FNA)诊断甲状腺恶性结节的临床应用价值。方法选取甲状腺结节患者134例共137个结节(恶性93例,良性44例),超声引导下每个结节先后运用22 G细针及18 G粗针穿刺取材,与手术病理及临床随访结果对照分析,比较FNA、CNB及CNB/FNA取材成功率及诊断甲状腺恶性结节的准确性、灵敏度及特异度。结果本组病例FNA,CNB和FNA/CNB穿刺取材成功率分别为89.1%、97.8%及100%,诊断甲状腺恶性结节准确性分别为79.6%、91.9%及96.4%,灵敏度分别为81.7%、94.6%及97.8%,特异度分别为75.0%、86.4%及93.2%。CNB及FNA/CNB的取材成功率明显高于FNA(P<0.01),诊断甲状腺恶性结节的准确性及灵敏度均明显高于FNA(P<0.01)。结论 CNB诊断甲状腺恶性结节准确、安全可靠,可以作为FNA的补充或者替代技术在临床推广应用。

Objective To retrospectively analyze and compare the clinical application value of core-needle biopsy(CNB)histology and fine needle aspiration(FNA)cytology in diagnosing malignant thyroid nodules.Methods A total of 134 patients with 137 thyroid nodules(93 malignant nodules and 44 benign nodules)were included in this study.Under ultrasound guidance,successive use of 22 G fine needle and18 G core-needle to puncture each nodule was performed for sampling of thyroid nodule.Surgical findings and pathological manifestations were compared with clinical follow-up results.The success rate of sampling and the diagnostic accuracy,sensitivity as well as specificity for malignant thyroid nodules were compared among FNA,CNB,and CNB/FNA.Results The success rate of puncture sampling with FNA,CNB and FNA/CNB for thyroid nodules was 89.1%,97.8%and 100%respectively.For malignant thyroid nodules,the diagnostic accuracy of FNA,CNB and FNA/CNB was 79.6%,91.9%and 96.4%respectively,the sensitivity was 81.7%,94.6%and 97.8%respectively,and the specificity was 75.0%,86.4%and 93.2%respectively.The success rate of puncture sampling by using CNB or FNA/CNB was significantly higher than that by using FNA(P<0.01),moreover,the diagnostic accuracy and sensitivity for malignant thyroid nodules by using CNB or FNA/CNB was also remarkably higher than those by using FNA(P<0.01).Conclusion In making diagnosis of malignant thyroid nodules,CNB is accurate,safe and reliable.CNB can be used as a complementary or alternative technique to FNA in clinical practice.