超声引导下粗针穿刺活检联合细针穿刺活检在甲状腺结节良恶性诊断中的效能

Efficiency of ultrasound-guided coarse needle biopsy in diagnosis of benign and malignant thyroid nodules

目的:分析超声引导下粗针穿刺活检(US-CNB)联合超声引导下细针穿刺活检(US-FNAB)在甲状腺结节良恶性诊断中的效能。方法:选取2020年7月至2022年7月该院收治的98例甲状腺结节患者进行前瞻性研究,所有患者均行US-CNB和US-FNAB检测,以术后病理组织切片检测结果为“金标准”,比较US-CNB、US-FNAB单项及联合检测在甲状腺结节良恶性诊断中的效能和Bethesda分类检出率。结果:金标准结果显示,98例甲状腺结节患者中,阳性42例,阴性56例;US-CNB检测结果显示,阳性30例,阴性68例,US-FNAB检测结果显示,阳性31例,阴性67例;US-CNB联合US-FNAB检测结果显示,阳性41例,阴性57例。Bethesda分类结果显示,BethesdaⅡ类24例、BethesdaⅢ类32例、BethesdaⅣ类15例、BethesdaⅤ类19例、BethesdaⅥ类8例。US-CNB、US-FNAB联合检测甲状腺结节良恶性的灵敏度、准确度及阳性预测值均高于US-CNB、US-FNAB单项检测,漏诊率低于US-CNB、US-FNAB单项检测,差异均有统计学意义(P<0.05)。US-CNB、US-FNAB单项及联合检测的特异度、误诊率、阳性预测值、阴性预测值比较,差异均无统计学意义(P>0.05);US-CNB、US-FNAB联合检测的BethesdaⅤ类检出率均高于US-CNB、US-FNAB单项检测,差异有统计学意义(P<0.05);US-CNB、US-FNAB单项及联合检测的BethesdaⅡ类、Ⅲ类、Ⅳ类、Ⅵ类检出率比较,差异均无统计学意义(P>0.05)。结论:US-CNB、US-FNAB联合检测诊断甲状腺结节良恶性的效能高于二者单项检测。

Objective:To analyze efficiency of ultrasound-guided core needle biopsy(US-CNB)in diagnosis of benign and malignant thyroid nodules.Methods:A prospective study was conducted on 98 patients with thyroid nodules admitted to the hospital from July 2020 to July 2022.All patients underwent US-CNB and ultrasound-guided fine needle aspiration cytology(US-FNAB).Using the results of pathological tissue section examination as the‘gold standard’,the efficacies of US-CNB and US-FNAB in the diagnosis of benign and malignant thyroid nodules were compared,and the detection rates of Bethesda classification were also compared.Results:The gold standard showed that among the 98 patients with thyroid nodules,42 were positive and 56 were negative.The US-CNB test showed that 30 cases were positive and 68 cases were negative.The USFNAB test showed that 31 cases were positive and 67 cases were negative.The US-CNB combined with US-FNAB detection showed that 41 cases were positive and 57 cases were negative.The Bethesda classification showed that there were 24 cases of Bethesda II,32 cases of Bethesda III,15 cases of Bethesda IV,19 cases of Bethesda V and 8 cases of Bethesda VI.The sensitivity,the accuracy and the positive predictive value of US-CNB combined with US-FNAB detection in the diagnosis of benign and malignant thyroid nodules by US-CNB and US-FNAB were higher than those of single detection of US-CNB and US-FNAB,the missed diagnosis rate was lower than that of single detection of US-CNB and US-FNAB,and the differences were statistically significant(P<0.05).There were no statistically significant differences in the specificity,misdiagnosis rate,positive predictive value,and negative predictive value of US-CNB,US-FNAB single and combined detections(P>0.05).The detection rate of Bethesda V of US-CNB combined with US-FNAB detection was higher than that of single detection of US-CNB and US-FNAB,and the differences were statistically significant(P<0.05).Conclusions:The diagnostic efficiency of US-CNB combined with US-FNAB detection in the diagnosis of benign and malignant thyroid nodules is higher than that of single detection.