超声引导下甲状腺小结节细针穿刺标本无法诊断的影响因素

Risk factors for failure in diagnosis of small thyroid nodules by ultrasound-guided fine needle aspiration

目的探讨甲状腺小结节超声引导下细针穿刺细胞学检查(US-FNA)标本无法诊断的影响因素。方法选取2018年10月至2020年6月在蚌埠市第三人民医院行US-FNA的甲状腺小结节患者298例,共332个结节。依据穿刺细胞学检查结果将结节分为Ⅰ~Ⅵ类,其中Ⅰ类为无法诊断,比较Ⅰ类结节与Ⅱ~Ⅵ类结节的超声特征。将单因素分析有统计学意义的参数纳入Logistic多因素回归,分析US-FNA标本无法诊断的影响因素。结果本组332个甲状腺结节穿刺细胞学结果显示,Ⅰ类结节43个,Ⅱ类结节143个,Ⅲ类结节15个,Ⅳ类结节11个,Ⅴ类结节81个,Ⅵ类结节39个。标本无法诊断的Ⅰ类结节占12.9%(43/332)。单因素分析结果发现,Ⅰ类结节与Ⅱ~Ⅵ类结节的直径、回声、钙化和血供差异存在统计学意义(P均<0.05)。多因素Logistic回归分析结果显示,结节直径≤0.5 cm(OR=6.488,95%CI:2.905~14.491,P<0.001)、低回声(OR=9.027,95%CI:1.107~73.582,P=0.040)、无血供(OR=4.016,95%CI:1.226~13.148,P=0.022)、环状钙化(OR=6.458,95%CI:1.422~29.331,P=0.016)是US-FNA标本无法诊断的独立影响因素。结论低回声、结节直径≤0.5 cm、结节无血供、环状钙化是影响甲状腺小结节细针穿刺标本无法诊断的主要因素。

Objective To identify the factors responsible for cytological failure in diagnosis of small thyroid nodules by ultrasound-guided fine needle aspiration(US-FNA).Methods A total of 298 patients with small thyroid nodules underwent US-FNA at Bengbu Third People's Hospital from October 2018 to June 2020.Nodules were classified into categoriesⅠ-Ⅵaccording to the results of puncture cytology examination,in which classⅠwas undiagnostic,and the ultrasonic characteristics of classⅠand classesⅡ-Ⅵnodules were compared.Statistically significant parameters from univariate analysis were included in Logistic multivariate regression to analyze factors responsible for failed diagnosis in US-FNAspecimens.Results Atotal of 332 thyroid nodules were included,of which 43 were classⅠnodules,143 classⅡ,15 classⅢ,11 classⅣ,81 classⅤ,and 39 classⅥ.ClassⅠnodules were undiagnosed ones,accounting for 12.9%(43/332).The univariate analysis demonstrated significant differences in diameter,echo,calcification,and blood supply between classⅠand classesⅡ-Ⅵnodules(P<0.05).The multivariate Logistic regression analysis demonstrated that nodular diameter≤0.05(odds ratio[OR]=6.488,95%confidence interval[CI]:2.905-14.491,P<0.001),low echo(OR=9.027,95%CI:1.107-73.582,P=0.040),no blood supply(OR=4.016,95%CI:1.226-13.148,P=0.022),and circular calcification(OR=6.458,95%CI:1.422-29.331,P=0.016)were independent risk factors for failed diagnosis of US-FNA specimens.Conclusion Nodular diameter≤0.05,low echo,no blood supply,and circular calcification are independent risk factors for failed diagnosis of fine needle puncture specimens.