超声引导甲状腺结节FNA标本满意度影响因素的分析

Influencing factors of specimen satisfactions of ultrasound-guided FNA for thyroid nodules

目的探讨影响超声引导甲状腺结节FNA标本满意度的各种因素。方法回顾性分析东莞市人民医院2016年6月至2019年12月初诊超声检查发现甲状腺结节但此前未经治疗的522例患者资料,根据细胞学结果,将BethesdaI类的细胞学穿刺标本定义为不满意,BethesdaⅡ~Ⅵ类的细胞学穿刺标本定义为满意,评估甲状腺结节大小、成分、钙化、ACRTI-RADS分类、穿刺次数以及甲状腺微小结节(≤1 cm)特殊位置等因素对甲状腺结节FNA标本满意度的影响。结果本研究总体标本满意度为82.4%(446/541),其中钙化标本满意度分别为点状钙化88.7%(196/221)、环状钙化56.0%(14/25)、粗大钙化79.2%(84/106)、无钙化80.4%(152/189);ACR TI-RADS分类的标本满意度分别为TR1~3为65.4%(17/26)、TR4为78.4%(120/153)、TR5为85.4%(309/362);甲状腺微小结节跟被膜关系的标本满意度分别为靠近前被膜83.2%(109/131)、靠近后被膜85.3%(64/75)、中部69.7%(62/89);钙化、ACR TI-RADS分类和甲状腺微小结节跟被膜关系与标本满意度之间比较,差异有统计学意义(P<0.05);甲状腺结节大小、成分、穿刺次数、甲状腺微小结节是否靠近气管、颈动脉、是否位于甲状腺上级的标本满意度基本与总体标本满意度持平,组内差异均无统计学意义(均P>0.05)。结论环状钙化、ACR TI-RADS 1~3类和位于腺体中部甲状腺小结节是降低甲状腺结节FNA标本满意度的影响因素,超声引导甲状腺FNA术前应该对甲状腺结节超声表现进行准确评估,穿刺过程中避开环状钙化,控制提插范围等方法来提高取材细胞量和标本满意度。

Objective To investigate the factors influencing the specimen satisfaction of ultrasound-guided FNA foe thyroid nodules.Methods The data of 522 patients found with thyroid nodules by ultrasound for the first time and took no treatment before at Dongguan People's Hospital from June,2016 to December,2019 were retrospectively analyzed.According to he cytological results,the BethesdaIspecimens were defined as unsatisfied,and the BethesdaⅡ-Ⅵones were defined as satisfied.The influences of thyroid nodule size,compositions,calcification,TI-RADS classification,puncture times,and special location of thyroid micro-nodules(≤1 cm)on FNA specimen satisfactions of thyroid nodules were evaluated.Results The overall specimen satisfaction was 82.4%(446/541).The specimen satisfactions of calcification were reported as below:nodules with punctate calcification 88.7%(196/221),nodules with peripheral calcification 56.0%(14/25),nodules with macro-calcification 79.2%(84/106),and nodules with no calcification 80.4%(152/189).The specimen satisfactions of ACR TI-RADS classification were as below:TR1-365.4%(17/26),TR478.4%(120/153),and TR585.4%(309/362).The specimen satisfactions of whether near the capsule were as below:nodules near the anterior capsule 83.2%(109/131),nodules near the posterior capsule 85.3%(64/75),and nodules in the middle of the gland 69.7%(62/89).Nodules with calcification,ACR TI-RADS classification,and thyroid micro-nodules associated with capsule were statistically significant(P<0.05).The specimen satisfactions of thyroid nodule size,composition,number of punctures,thyroid micro-nodules near the trachea,carotid artery,or at the upper pole of the thyroid were basically the same as the overall specimen satisfaction,with no statistical difference between the groups.Conclusion Peripheral calcification,ACR TI-RADS TR1-3,and thyroid micro-nodules located in the middle of the gland are theinfluence factors that reduce the specimen satisfaction of thyroid nodules FNA.Sonographic findings of thyroid nodule should be accurately evaluated before ultrasound-guided thyroid FNA,peripheral calcification avoided in the process of puncture,and the range of lift and insertion controlled to improve cell numbers and specimen satisfaction.