超声引导下粗针穿刺组织学与细针穿刺细胞学检查对甲状腺结节诊断的意义对比

Comparison of the significance of ultrasound-guided core-needle biopsy histology and fine needle aspiration cytology in the diagnosis of thyroid nodules

目的 对比超声引导下粗针穿刺组织学(US-CNB)与超声引导下细针穿刺细胞学(US-FNAB)检查甲状腺结节的准确率、灵敏度及特异度。方法 选取97例二维超声检查结果疑似恶性甲状腺结节患者,根据穿刺方法不同分为粗针穿刺组(45例, 49个结节)和细针穿刺组(52例, 55个结节)。粗针穿刺组行US-CNB检查,细针穿刺组行US-FNAB检查;细针穿刺组中首次穿刺诊断结果为BethesdaⅢ类的结节二次穿刺改行粗针穿刺。以术后病理诊断结果为金标准,对比两组的取材满意率、成功率、并发症发生情况及诊断结果 (准确率、灵敏度、特异度),细针穿刺+粗针穿刺(首次细针穿刺为BethesdaⅢ类)与粗针穿刺的诊断结果 (准确率、灵敏度、特异度)。结果 粗针穿刺组失败2个,成功率为95.9%(47/49, 2个失败的剔除出后续对比),取材满意率为97.9%(46/47);细针穿刺组无失败病例,成功率为100.0%,取材满意率为89.1%(49/55)。粗针穿刺组并发症发生率19.1%(9/47)高于细针穿刺组的3.6%(2/55),差异有统计学意义(χ~2=6.339, P=0.012<0.05)。细针穿刺组诊断甲状腺结节的准确率、灵敏度、特异度分别为79.59%(39/49)、80.95%(34/42)、71.43%(5/7),粗针穿刺组诊断甲状腺结节的准确率、灵敏度、特异度分别为93.48%(43/46)、94.87%(37/39)、85.71%(6/7)。粗针穿刺组准确率明显高于细针穿刺组,差异有统计学意义(P<0.05);两组灵敏度、特异度比较,差异无统计学意义(P>0.05)。细针穿刺组首次穿刺中共7个结节诊断结果显示为BethesdaⅢ类,重复穿刺采用粗针穿刺,最终穿刺病理结果显示7个结节中3个为恶性, 4个为良性。细针穿刺+粗针穿刺(首次细针穿刺为BethesdaⅢ类)的准确率、灵敏度、特异度分别为85.71%(42/49)、88.10%(37/42)、71.43%(5/7),与粗针穿刺比较差异无统计学意义(P>0.05)。结论 US-FNAB和US-CNB在甲状腺结节良恶性诊断中各有利弊,可互相补充,建议临床首选US-FNAB,以降低不必要的粗针穿刺风险,若穿刺结果为BethesdaⅢ类,二次穿刺可选USCNB,以求进一步提高穿刺准确率,降低误诊率。

Objective To compare the accuracy,sensitivity and specificity of ultrasound-guided coreneedle biopsy histology(US-CNB)and ultrasound-guided fine needle aspiration cytology(US-FNAB)in the diagnosis of thyroid nodules.Methods A total of 97 patients with suspected malignant thyroid nodules by twodimensional ultrasonography were selected and divided into core-needle aspiration group(45 cases,49 nodules)and fine needle aspiration group(52 cases,55 nodules)according to different puncture methods.US-CNB was performed in the core-needle aspiration group,and US-FNAB was performed in the fine-needle aspiration group.In the fine needle aspiration group,the second aspiration of nodes with a first aspiration diagnosis of Bethesda classⅢwas changed to core-needle aspiration.The results of postoperative pathological findings were used as the gold standard to compare the satisfactory sampling rate,success rate,complication occurrence and diagnostic results between the two groups,and the diagnostic results of fine needle aspiration+core needle aspiration(the first fine needle aspiration was Bethesda ClassⅢ)and core needle aspiration.Results 2 failed nodules in the core-needle puncture group,with a success rate of 95.9%(47/49,2 failed nodules were excluded from the follow-up comparison)and a satisfactory sampling rate of 97.9%(46/47);there were no failed cases in the fine needle puncture group,with a success rate of 100.0%and a satisfactory sampling rate of 89.1%(49/55).The complication rate 19.1%(9/47)of the core-needle aspiration group was higher than 3.6%(2/55)of the fine needle aspiration group,and the difference was statistically significant(χ2=6.339,P=0.012<0.05).The accuracy,sensitivity and specificity of the fine needle aspiration group for the diagnosis of thyroid nodules were 79.59%(39/49),80.95%(34/42)and 71.43%(5/7),while the accuracy,sensitivity and specificity of the core-needle aspiration group for the diagnosis of thyroid nodules were 93.48%(43/46),94.87%(37/39)and 85.71%(6/7).The accuracy rate of the core-needle aspiration group was significantly higher than that of the fine needle aspiration group,and the difference was statistically significant(P<0.05).The differences were not statistically significant when comparing the sensitivity and specificity of the two groups(P>0.05).A total of seven nodules in the first aspiration in the fine needle aspiration group showed diagnostic results of Bethesda classⅢ,and repeated aspirations were performed with core needle aspiration,and the final aspiration pathology showed that 3 of the 7 nodules were malignant and 4 were benign.The accuracy,sensitivity and specificity of fine needle aspiration and core-needle aspiration(the first fine needle aspiration was BethesdaⅢ)were 85.71%(42/49),88.10%(37/42)and 71.43%(5/7),there was no statistically significant difference when compared with those of the core-needle aspiration(P>0.05).Conclusion Both US-FNAB and US-CNB have advantages and disadvantages in the diagnosis of benign and malignant thyroid nodules and can complement each other.It is recommended that US-FNAB be preferred to reduce the risk of unnecessary coarse needle puncture,and if the puncture result is Bethesda classⅢ,US-CNB is optional for the second puncture to further improve the puncture accuracy and reduce the misdiagnosis rate.