超声引导下细针穿刺甲状腺结节Bethesda Ⅰ类标本的影响因素

Influencing factors of BethesdaⅠof thyroid nodules under ultrasound-guided fine needle aspiration

近年来,甲状腺结节检出率显著升高,不同病理类型的甲状腺癌存活率不同,但大多数甲状腺癌预后较好。这使得对恶性结节尽早做出明确诊断至关重要,超声引导下细针穿刺细胞学检查(ultrasound-guided finenee dleaspiration biopsy,US-FNAB)是甲状腺结节术前定性诊断的主要方法,但其最主要的缺点在于标本无法诊断或不满意(BethesdaⅠ类),其影响因素为操作者熟练程度、结节特征、穿刺工具、穿刺方法、标本现场评估、其他,其解决方法为重复穿刺、立体定向三点一线择优穿刺法、检测肿瘤标志物、成立活检中心、现场视觉评估、粗针穿刺活检、薄层液基细胞涂片法。

In recent years,the detection rate of thyroid nodules has increased significantly.Different types of thyroid cancer have different survival rates,but most thyroid cancers have a good prognosis.This makes it important to make a definitive diagnosis of malignant nodule as soon as possible.Ultrasound guided fine needle aspiration biopsy(US-FNAB)is the main method for qualitative diagnosis of thyroid nodules before operation.However,its major disadvantage is that the specimen cannot be diagnosed or is unsatisfactory(BethesdaⅠtype).The influencing factors are operator proficiency,nodule characteristics,puncture tools,puncture methods,immediate assessment of specimens,etc.and solutions are repeated puncture,stereotactic three-point and one-line selective puncture method,detection of tumor markers,setting up a biopsy center,on-site visual assessment,thick needle aspiration biopsy,thin layer liquid-based cell smear method.