针吸细胞学检查在诊断甲状腺结节中的病理临床应用研究

Clinical application of needle aspiration cytology in diagnosis of thyroid nodules

目的探讨FNAC在诊断甲状腺结节中的病理临床应用。方法随机抽取河南中医药大学第一附属医院2017年1月-2018年12月甲状腺结节门诊及住院患者共264例,分析评估针吸细胞学检查(Fine Needle Aspiration Cytology简称FNAC)与手术切除标本的诊断复合率。结果针吸细胞学检查的特异性较高为91.6%,敏感性较低为86.7%,术前针吸细胞学检查与术后组织病理诊断总体符合率为88.8%,尤其对甲状腺乳头状癌诊断符合率可高达100%,与总体诊断符合率相比差异无统计学意义;对甲状腺滤泡性肿瘤(包括滤泡性腺瘤、滤泡性癌)的诊断符合率较低,仅为10.1%,与总体诊断符合率相比差异有统计学意义(P<0.05)。结论 FNAC技术能筛选出大多数良性病变如结节性甲状腺肿、腺瘤等占84.8%,而极少数为可疑乳头状癌或乳头状癌,分别占3%或36%,而对于穿刺不满意或无法诊断仅占1%。FNAC术前诊断与术后组织学诊断相比,良性病变的诊断符合率平均达93.8%,乳头状癌的诊断符合率高达100%。针吸细胞学检查对甲状腺良性病变及恶性肿瘤诊断价值较高,尤其对甲状腺乳头状癌的诊断准确性高,术前与术后诊断符合率高达100%。甲状腺穿刺细胞学检查联合BRAF V600E检测有利于提高术前甲状腺乳头状癌的检出率,但BRAF V600E突变的临床应用价值尚不明确。

Objective To investigate the pathological and clinical application of FNAC in the diagnosis of thyroid nodules.Methods A total of 264 outpatients and inpatients with thyroid nodules were randomly selected from January 2017 to December 2018. The diagnostic composite rate of Fine Needle Aspiration Cytology(FNAC) and surgical resection specimens was analyzed and evaluated.Results The specificity and sensitivity of fine needle aspiration cytology were 91.6% and 86.7% respectively. The overall coincidence rate between pre-operative fine needle aspiration cytology and post-operative histopathological diagnosis was 88.8%. The coincidence rate of diagnosis for papillary thyroid cancer was 100%. There was no significant difference between the coincidence rate of fine needle aspiration cytology and general diagnosis. The diagnostic coincidence rate of sex tumors(including follicular adenoma and follicular carcinoma) was only 10.1%, which was significantly lower than the overall diagnostic coincidence rate(P<0.05).Conclusion Most benign lesions, such as nodular goiter and adenoma, can be screened by FNAC, accounting for 84.8%, while a few of them are suspicious papillary or papillary carcinomas, accounting for 3% or 36%, respectively, while only 1% are unsatisfactory or unable to diagnose. The diagnostic accuracy of FNAC was 93.8% for benign lesions and 100% for papillary carcinomas. Fine needle aspiration cytology has high diagnostic value for benign and malignant thyroid lesions, especially for papillary thyroid cancer. The coincidence rate between preoperative and postoperative diagnosis is as 100%. Thyroid puncture cytology combined with BRAF V600 E detection is helpful to improve the detection rate of preoperative papillary thyroid cancer, but the clinical value of BRAF V600 E mutation is still unclear.