超声引导下细针抽吸细胞学与粗针穿刺组织学在甲状腺微小结节诊断中的应用效果比较

Application value of ultrasound-guided fine needle aspiration biopsy and core needle aspiration in the diagnosis of thyroid micronodules

目的比较超声引导下细针抽吸细胞学(US-FNAB)与粗针穿刺组织学(US-CNA)在甲状腺微小结节诊断中的应用效果。方法回顾性分析商丘市第一人民医院2017年10月至2019年10月经超声怀疑为恶性甲状腺微小结节102例患者的临床资料,依据穿刺方式不同将其分为US-CNA组(47例)和US-NFAB组(55例),记录两组手术病理结果,比较两组取材情况、术后出血情况,并分析US-CNA和US-NFAB鉴别良恶性甲状腺结节的诊断效能。结果经手术病理证实,102例甲状腺微小结节患者中恶性结节85例,良性结节17例,其中US-CNA组恶性结节40例,良性结节7例,US-NFAB组恶性结节45例,良性结节10例;US-NFAB组取材细胞量少发生率显著US-CNA组(P<0.05),US-NFAB组取材细胞量多的成功率高于US-CNA组(P<0.05);US-NFAB组术后出血情况的等级资料显著优于US-CNA组(P<0.05);以手术病理证实结果为金标准,US-CNA鉴别良恶性甲状腺微小结节的灵敏度、特异度、阳性预测值、阴性预测值及诊断精确率分别为87.50%、85.71%、97.22%、54.55%及87.23%,US-NFAB鉴别良恶性甲状腺微小结节的灵敏度、特异度、阳性预测值、阴性预测值及诊断精确率分别为93.33%、90.00%、97.67%、75.00%及92.73%。结论US-FNAB在鉴别良恶性甲状腺微小结节诊断价值高,且具有取材成功率高和术后出血情况少等优势。

Objective To explore the application value of ultrasound-guided fine needle aspiration biopsy(US-FNAB)and core needle aspiration(US-CNA)in the diagnosis of thyroid micronodules.Methods The data of 102 patients with suspected malignant thyroid micronodules by ultrasound in Shangqiu First People’s Hospital from October 2017 to October 2019 were retrospectively analyzed.The patients were divided into US-CNA group(n=47)and US-NFAB group(n=55)according to the different puncture methods.The surgical pathological results were recorded in the two groups,and thematerial selectionand postoperative blood loss were compared between the two groups,and the diagnostic efficacy of US-CNA and US-NFAB in distinguishing benign and malignant thyroid micronodules was analyzed.Results As confirmed by surgery and pathology,there were 85 cases of malignant nodules and 17 cases of benign nodules among 102 cases of thyroid micronodules.Among them,there were 40 cases of malignant nodules and 7 cases of benign nodules in US-CNA group,and there were 45 cases of malignant nodules and 10 cases of benign nodules in US-NFAB group.The incidence rate of less cells in material selection in US-NFAB group was significantly lower than that in US-CNA group(P<0.05),and the success rate of more cells in material selection in US-NFAB group was significant higher than those in US-CNA group(P<0.05).The grade data of postoperative bleeding in US-NFAB group was significantly better than that in US-CNA group(P<0.05).Taking surgical pathological confirmation result as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of US-CNA respectively were 87.50%,85.71%,97.22%,54.55%and 87.23%,the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of US-NFAB respectively were 93.33%,90.00%,97.67%,75.00%and 92.73%.Conclusions US-FNAB has high diagnostic value in differentiating benign and malignant thyroid micronodules,and has the advantages of high success rate of material selection and little postoperative blood loss.