穿刺针数对甲状腺结节超声引导细针抽吸细胞学检查诊断效能的影响

Effect on the number of aspirates on the accuracy of ultrasound-guided fine-needle aspiration cytology in thyroid nodules

目的:评价穿刺针数对超声引导下甲状腺细针抽吸细胞学检查(ultrasound-guided fine-needle aspiration cytology,US-FNAC)诊断效能的影响。方法:收集2015年6月—2018年6月于南京医科大学附属南京医院(南京市第一医院)行US-FNAC并经手术治疗的甲状腺结节患者352例,共352个结节,每个结节穿刺4针,病理科医师在穿刺现场依据甲状腺细胞病理学Bethesda报告系统(The Bethesda System for Reporting Thyroid Cytopathology,TBSRTC)进行细胞学诊断。按照总的穿刺针数分为A组(第1针)、B组(前2针)、C组(前3针)、D组(前4针)4组,将所有结节的细胞学穿刺结果与术后组织病理学检查结果比较,分为符合和不符合两类,分别计算灵敏度、特异度和准确度。结果:A、B、C、D 4组的灵敏度分别为70.8%、85.6%、94.2%、97.8%,特异度分为别55.0%、75.0%、100.0%、100.0%,准确度分别为69.0%、84.4%、94.9%、98.0%,差异均有统计学意义(P<0.001);组间比较,A、B、C组间两两比较各项统计指标差异均有统计学意义(P<0.008);C、D两组间差异无统计学意义(P>0.008)。结论:穿刺灵敏度、特异度及准确度随针数增加而增加,但综合考虑,3针在未出现并发症的基础上穿刺效能最高,可作为常规推荐。

Objective:To evaluate the effect on the number of aspirates on the diagnostic efficacy of ultrasound-guided fineneedle aspiration cytology(US-FNAC)in thyroid nodules.Methods:From June 2015 to June 2018,352 patients were operated USFNAC and thyroidectomy.Each nodule was aspirated 4 times.Cytopathologist diagnosed specimen based on The Bethesda System for Reporting Thyroid Cytopathology(TBSRTC)on-site.According to the total numbers of aspiration,cytological results were divided into four groups:group A(1st needle),group B(first 2 needles),group C(first 3 needles),and group D(total 4 needles).Yields of US-FNAC were divided into two levels of accuracy and inaccuracy according to the pathological results of paraffin and diagnostic accuracy was calculated separately.Results:The sensitivity of group A,B,C,D were 70.8%,85.6%,94.2%,97.8%.The specificity of group A,B,C,D were 55.0%,75.0%,100.0%,100.0%.The accuracy of group A,B,C,D were 69.0%,84.4%,94.9%,98.0%,respectively.The sensitivity,specificity and accuracy of four groups showed statistically significant difference(P<0.001).There were statistically significant differences in 3 parameters between group A,group B and group C(P<0.008).Group C and D showed no statistically significance(P>0.008).Conclusion:The sensitivity,specificity,and accuracy of aspiration increase with the number of needles.However,comprehensively considered,the 3 needles have the highest efficiency of aspiration on the basis of no complications,and can be used as a routine recommendation..