细针穿刺细胞学联合洗脱液甲状腺球蛋白检测对甲状腺癌颈部淋巴结转移诊断价值

Diagnostic Value of Fine Needle Aspiration Cytology Combined with Eluate Thyroglobulin Test for Thyroid Cancer Neck Lymph Node Metastasis

目的:探究细针穿刺细胞学联合细针穿刺洗脱液测量甲状腺球蛋白对甲状腺乳头状癌颈部淋巴结转移的诊断价值。方法:选取2016年4月至2019年12月于我院接受治疗的考虑为甲状腺乳头状癌患者共90例,依据诊断方法不同分为A组、B组及联合组各30例。A组患者接受细针穿刺活检,B组患者接受洗脱液甲状腺球蛋白检测,联合组患者接受两种检测方法,并以患者手术后病理学结果为诊断金标准。比较在不同诊断方法下患者的诊断结果。结果:A组患者淋巴结样本5枚Ⅱ区、13枚Ⅲ区、12枚取自Ⅳ区,术后病理学诊断结果:27例阳性,3例阴性;B组患者淋巴结样本3枚Ⅱ区、14枚Ⅲ区、13枚取自Ⅳ区,术后病理学结果:25例阳性,5例阴性;联合组患者淋巴结样本4枚Ⅱ区、12枚Ⅲ区、14枚取自Ⅳ区,术后病理学结果:28例阳性,2例阴性。联合组特异度、约登指数明显高于A、B两组(P<0.05),A组阴性预测值、灵敏度明显低于B组与联合组(P<0.05),阳性预测值联合组明显高于B组(P<0.05),与A组无明显差异(P>0.05)。根据B组与联合组诊断结果,PTC阳性患者51例,FNA-Tg浓度(171.45±42.33)μg/L,阴性患者9例,FNA-Tg浓度(20.63±11.57)μg/L,两类患者比较t=21.328,P=0.000;以FNA-Tg浓度为分类标准做ROC曲线(下面积0.972±0.020,P=0.000,95%CI=0.932~1.000),以98.5μg/L为诊断截断值,灵敏度为86.27%,特异度100.00%。以病理学检验为标准,A组检验方法Kappa值=0.103,B组检验方法Kappa值=0.280,两组与病理学检测标准一致性较差(P>0.05);联合组与病理学检测结果一致性较高(P<0.05),一致性一般(Kappa值=0.634)。结论:FNAC联合FNA-Tg诊断方法与病理学诊断存在一致性,两种方法结合可互补各自不足,对于PTC患者淋巴结转移诊断具有一定价值。

Objective:To explore the diagnostic value of fine needle aspiration cytology combined with eluate thyroglobulin test for thyroid cancer neck lymph node metastasis.Methods:A total of 90 patients with suspected thyroid cancer who were treated in our hospital from April 2016 to June 2019 were selected and divided into group A,group B and joint group according to different detection methods.Patients in group A underwent fine needle biopsy,patients in group B underwent eluent thyroglobulin assay,and patients in the joint group underwent both tests.The gold standard for diagnosis was the pathological findings after surgery.The diagnosis results of patients with different diagnosis methods were compared.Results:Group A patients had 5 lymph node samples from zone II,13 from zone III and 12 from zone IV.Postoperative pathological findings:27 positive,3 negative Group B patients had 3 lymph node samples from zone II,14 from zone III,and 13 from zone IV,with postoperative pathological findings:25 positive and 5 negative.The joint group patients had 4 lymph node samples from zone II,12 from zone III,and 14 from zone IV.The postoperative pathological findings were 28 positive cases and 2 negative cases.The specificity and yoden index of the joint group were significantly higher than those of group A and group B(P<0.05),the negative predictive value and sensitivity of group A were significantly lower than those of group B and the joint group(P<0.05),and the positive predictive value of the joint group was significantly higher than that of group B(P<0.05),with no significant difference from group A(P>0.05).According to the test results of group B and the joint group,FNA-Tg concentration was(171.45±42.33)μg/L in 51 patients with positive PTC,and(20.63±11.57)μg/L in 9 patients with negative PTC.The ROC curve was plotted with FNA-Tg concentration as the classification standard(lower area 0.972±0.020,P=0.000,95%CI=0.932~1.000),and the diagnostic cut-off value was 98.5μg/L,with a sensitivity of 86.27%and specificity of 100.00%.Using the pathology test as the standard,the Kappa value of the test in group A=0.103 and the Kappa value of the test in group B=0.280,the consistency between the two groups and the pathology test standard was poor(P>0.05);the consistency between the joint group and the pathology test results was high(P<0.05)and the consistency was average(Kappa value=0.634)Conclusion:FNAC combined with FNA-Tg is consistent with pathological diagnosis,and the combination of the two methods can complement each other,which is of certain value for the diagnosis of lymph node metastasis in TC patients.