甲状腺细针穿刺活检在甲状腺良恶性疾病诊断中漏诊和误诊情况的影响因素分析

Analysis of factors influencing missed diagnosis and misdiagnosed cases of thyroid fine needle aspiration biopsy in the diagnosis of benign and malignant thyroid diseases

目的分析甲状腺细针穿刺活检在甲状腺良恶性疾病诊断中漏诊和误诊的影响因素。方法回顾性分析2020年5月至2021年5月本院收治的64例甲状腺疾病患者的临床资料,均行甲状腺细针穿刺活检,分析甲状腺细针穿刺活检在甲状腺病变良恶性诊断中漏诊和误诊的影响因素。结果64例研究对象中男16例,女48例;甲状腺超声检查结果中,甲状腺结节直径<1.5 cm 15例,结节直径为1.5~2.5 cm 37例,结节直径>2.5 cm 12例。超声检查提示实性低回声44例,混合回声7例,高回声13例。以手术病理检查结果作为诊断的金标准,甲状腺细针穿刺活检的误诊率为17.19%,漏诊率为4.69%。两种检查方法诊断结果比较差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、病灶大小和超声回声强度是甲状腺细针穿刺检查漏诊和误诊的影响因素(P<0.05)。结论甲状腺细针穿刺活检的漏诊率较低,对于年纪较小、病灶较少且超声检查提示高回声的甲状腺疾病患者,应在甲状腺细针穿刺检查后再行手术取病理进行活检,避免出现漏诊而延误患者的病情。

Objective To analyze the factors influencing missed diagnosis and misdiagnosed cases of thyroid fine needle aspiration biopsy in the diagnosis of benign and malignant thyroid diseases.Methods The clinical data of 64 patients with thyroid disease admitted to our hospital from May 2020 to May 2021 were retrospectively analyzed,all of whom underwent fine needle aspiration biopsy of the thyroid,and to analyze the influencing factors of missed diagnosis and misdiagnosis of fine needle aspiration biopsy of the thyroid in the diagnosis of benign and malignant thyroid lesions.Results Among the 64 subjects,16 cases were males and 48 cases were females;in the results of thyroid ultrasonography,15 cases had thyroid nodules with diameters<1.5 cm,37 cases had nodules with diameters of 1.5-2.5 cm,and 12 cases had nodules with diameters>2.5 cm.Ultrasonography showed solid hypoechoic in 44 cases,mixed echo in 7 cases,and hyperechoic in 13 cases.Taking surgical and pathological examination results as the gold standard for diagnosis,the misdiagnosis rate of thyroid fine needle aspiration biopsy was 17.19%,and the missed diagnosis rate was 4.69%,there was statistically significant difference in the diagnostic results of the two methods(P<0.05).The results of multivariate Logistic regression analysis showed that age,lesion size and ultrasound echo intensity were the influencing factors of missed diagnosis and misdiagnosis of thyroid fine needle aspiration(P<0.05).Conclusion The missed diagnosis rate of thyroid fine needle biopsy is low,for patients with thyroid diseases of younger age,less lesions and high echo indicated by ultrasound examination,pathological biopsy should be performed after thyroid fine needle biopsy to avoid missed diagnosis and delay the patient's condition.