甲状腺结节细针穿刺活检假阳性诊断的细胞学及超声特征分析

Analysis of cytopathologic and sonographic features for false-positive diagnosis in fine-needle aspiration of thyroid nodules

目的分析甲状腺结节细针穿刺活检(FNA)假阳性诊断病例的细胞学及超声特征,探讨能否提高其诊断效能。方法收集2016年1月至2020年9月在中山大学附属第三医院行超声引导下甲状腺结节FNA且经手术病理证实为假阳性诊断病例的基本资料、甲状腺超声检查资料、FNA资料、细胞学判读及手术病理资料进行分析。结果行超声引导下甲状腺结节FNA的患者共2626例,共活检2971个结节。1061个结节(35.7%)进行手术病理诊断,817个结节(77.0%)手术病理诊断为恶性,748个结节(70.5%)细胞学判读为Bethesda报告系统(TBSRTC)Ⅴ~Ⅵ类。以TBSRTCⅤ类或Ⅵ类定义为细胞学判读阳性,共21例患者23个甲状腺结节为假阳性诊断,细胞学判读均为TBSRTCⅤ类,其假阳性诊断率为9.4%。18例患者(85.7%)甲状腺功能正常,13例患者(61.9%)甲状腺相关抗体阴性。所有结节在细胞学上均表现出甲状腺乳头状癌的部分核特征,但尚不足以作出明确恶性诊断(TBSRTCⅥ类)。16个结节(69.6%)超声判断为ACR TI-RADS 2~4级,12个结节(52.2%)判断为C-TIRADS 3~4A类或超声良性,所有结节(100%)均未发现可疑颈部淋巴结。结论细胞学特征的重叠是甲状腺结节FNA假阳性诊断的主要原因。超声特征信息在降低假阳性诊断方面可能有一定作用。

Objective To analyze the cytopathologic and sonographic features of false-positive diagnosis in fine-needle aspiration(FNA)of thyroid nodules.Methods The false-positive diagnosis of thyroid nodules FNA which was confirmed by histopathology in the Affiliated Hospital of Sun Yat-sen University from Jan 2016 to Sep 2020 were collected and analyzed.Results A total of 2,626 patients with 2,971 thyroid nodules were performed ultrasonography(US)-guided FNA,and 1,061 thyroid nodules(35.7%)were confirmed by histopathology.Among these 1,061 nodules,817(77.0%)were histopathologic malignancy,and 748(70.5%)were cytopathologic malignancy(TBSRTCⅤ-Ⅵ).Twenty-one patients with 23 thyroid nodules were false-positive diagnosis,showing TBSRTCⅤ,with a false-positive rate of 9.4%.In these false-positive cases,18 patients showed normal thyroid function and 13 showed negative thyroid antibodies.All the false-positive nodules showed part of cytopathologic features of papillary thyroid carcinoma,but were insufficient to diagnose TBSRTCⅥ.In sonographic features,16 nodules(69.6%)were classified as ACR TI-RADS 2-4,12(52.2%)were classified as C-TIRADS 3-4A or sonographic benign,and none of the nodules were found suspicious cervical lymph nodes metastasis.Conclusions The overlapping of cytopathologic features is the main cause of false-positive diagnosis in thyroid nodules FNA.Sonographic features may play a role in decreasing the false-positive diagnosis.