细针穿刺细胞学检查与细针穿刺洗脱液甲状腺球蛋白检测在甲状腺乳头状癌患者颈部淋巴结转移诊断中的价值

Values of FNAC and FNA-Tg to the diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma

目的探讨细针穿刺细胞学检查(fine-needle aspiration cytology, FNAC)、细针穿刺洗脱液甲状腺球蛋白(thyroglobulin measurement in fine-needle aspiration biopsy, FNA-Tg)检测及二者联合在甲状腺乳头状癌(papillary thyroid carcinoma, PTC)患者颈部淋巴结转移诊断中的价值。方法行甲状腺切除并颈部淋巴结清扫的PTC患者195例,术前均行超声引导下颈部淋巴结FNAC,每例患者穿刺3针,前2针内容物行细胞学诊断;第3针内容物制备穿刺洗脱液,采用化学发光法测定FNA-Tg水平(FNA-Tg>10μg/L为淋巴结转移阳性)。以术后组织病理检查结果为金标准,计算FNAC、FNA-Tg及二者联合诊断PTC患者颈部淋巴结转移的灵敏度、特异度、准确率。采用Kappa检验评估FNAC、FNA-Tg检测及二者联合检查与术后组织病理检查结果的一致性。结果术后组织病理检查结果显示,195例PTC患者中颈部淋巴结转移77例,未转移118例;FNAC术前诊断PTC患者颈部淋巴结转移的灵敏度为72.73%,特异度为99.15%,准确率为88.72%,与术后组织病理检查结果一致性较好(Kappa=0.753,P<0.001);FNA-Tg检测术前诊断PTC患者颈部淋巴结转移的灵敏度为70.13%,特异度为96.61%,准确率为86.15%,与术后组织病理检查结果一致性一般(Kappa=0.697,P<0.001);二者联合术前诊断PTC患者颈部淋巴结转移的灵敏度为83.12%,特异度为96.61%,准确率为91.28%,与术后组织病理检查结果的一致性较好(Kappa=0.814,P<0.001)。结论 FNAC诊断PTC患者术前颈部淋巴结转移与术后组织病理检查结果一致性较好,联合FNA-Tg检测可进一步提高与术后组织病理检查结果的一致性。

Objective To investigate the values of single and combined application of fine-needle aspiration cytology(FNAC) and thyroglobulin measurement in fine-needle aspiration biopsy(FNA-Tg) to the diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma(PTC). Methods Totally 195 patients with PTC scheduled for thyroidectomy and cervical lymph node dissection received ultrasound guided cervical lymph node FNAC. Each patient received three times of FNAC. The contents of the first two punctures were used for FNAC. The content of the third puncture was used for eluent preparation, and FNA-Tg level was detected by chemiluminescence(FNA-Tg>10 ng/mL was set as the reference value of lymph node metastasis). The histopathologic results were taken as the gold standard to calculate the sensitivities, specificities and accuracies of single and combined application of FNAC and FNA-Tg for the diagnosis of cervical lymph node metastasis in patients with PTC. Kappa test was used to evaluate the consistency of single and combined application of FNA-Tg and FNAC with the postoperative histopathological results. Results The histopathologic results showed cervical lymph node metastasis in 118 patients and no cervical lymph node metastasis in 77 patients. The sensitivity, specificity and accuracy of preoperative FNAC in diagnosing cervical lymph node metastasis were 72.73%, 99.15% and 88.72%, respectively, with a good consistency(Kappa=0.753, P<0.001). The sensitivity, specificity and accuracy of preoperative FNA-Tg in diagnosing cervical lymph node metastasis were 70.13%, 96.61% and 86.15%, respectively, with a general consistency(Kappa=0.697, P<0.001). The sensitivity, specificity and accuracy of preoperative FNAC+FNA-Tg in diagnosing cervical lymph node metastasis were 83.12%, 96.61% and 91.28%, respectively, with a good consistency(Kappa=0.814, P<0.001). Conclusion FNAC has better consistency in the diagnosis of cervical lymph node metastasis in patients with PTC, and the combined detection of FNAC and FNA-Tg can increase the consistency with the postoperative histopathological results.