细针穿刺、粗针穿刺及两者联合诊断甲状腺结节的前瞻性对比研究

A prospective comparative study of fine needle aspiration,coarse needle biopsy,and their combination in the diagnosis of thyroid nodules

目的:对比研究超声引导下细针穿刺(FNA)、粗针穿刺(CNB)和粗细针穿刺结合(FNA+CNB)对同一甲状腺结节的诊断效能。方法:选取105例甲状腺结节患者(112个结节)作为研究对象,对每个结节同时行超声引导下细针(FNA)和粗针(CNB)穿刺,分别比较FNA、CNB、FNA+CNB对甲状腺结节的诊断效能;根据超声特征(结节最大径、粗大钙化、纵横比、囊实性)进行分组,比较FNA、CNB的诊断准确度。结果:剔除14个穿刺失败结节后,剩余98个结节进入研究,FNA、CNB取材成功率分别为89.4%、97.3%(P<0.05)。FNA、CNB、FNA+CNB诊断甲状腺结节的敏感度分别为93.1%、75.9%、100%,FNA、FNA+CNB优于CNB(P<0.05);特异度分别为60%、90%、57.5%,CNB优于FNA、FNA+CNB(P<0.05);阴性预测值分别为85.7%、72%、100%,FNA+CNB优于CNB(P<0.05)。ROC曲线分析显示,CNB曲线下面积(AUC)大于FNA(0.829 vs.0.766,P<0.05)。亚组分析中,对于直径<0.5 cm的结节,CNB诊断特异度高于FNA(100%vs.50%,P=0.014),FNA诊断敏感度高于CNB(93.3%vs.46.7%,P=0.033)。结节大小和纵横比可能会影响CNB的诊断结果,直径≥0.5 cm敏感度更高,纵横比≤1准确度更高(P<0.05);结节囊实性可能会影响FNA诊断结果,实性结节准确度更高(P<0.05)。结论:CNB对甲状腺结节良恶性的检出具有更高的诊断价值,但直径<0.5cm的结节使用FNA具有更高的敏感度。

Objective:To compare and analyze the diagnostic efficacy of ultrasound(US)guided fine needle aspiration(FNA),coarse needle biopsy(CNB),and combination of coarse and fine needle aspiration(FNA+CNB)for the same thyroid nodule.Methods:105 patients with thyroid nodul es(112 nodules)were selected,and ultrasound guided fine needle(FNA)and coarse needle(CNB)puncture were performed simultaneously on each nodule.The diagnostic efficacy of FNA,CNB,and FNA+CNB for thyroid nodules was compared,respectively.Grouping based on ultrasound features(maximum diameter of nodules,coarse calcification,aspect ratio,and cystic solidity)to compare the diagnostic accuracy of FNA and CNB.Results:After removing 14 failed puncture nodules,the remaining 98 nodules entered the study.The success rates for FNA and CNB puncture sampling were 89.4%and 97.3%,respectively(P<0.05).The sensitivity of FNA,CNB,and FNA+CNB were 93.1%,75.9%,and 100%,respectively,FNA and FNA+CNB were better than CNB(P<0.05).The specificity was 60%,90%,and 57.5%,respectively,CNB was superior to FNA and FNA+CNB(P<0.05).The negative predictive values were 85.7%,72%,and 100%,respectively,and FNA+CNB was superior to CNB(P<0.05).ROC curve analysis showed that the area under curve(AUC)of the CNB was greater than FNA(0.829 vs.0.766,P<0.05).In subgroup analysis,the diagnostic specificity of CNB was higher than that of FNA(100%vs.50%,P=0.014)and the diagnostic sensitivity of FNA was higher than that of CNB(93.3%vs.46.7%,P=0.033)for nodules<0.5 cm in diameter.The size and aspect ratio of nodules may affect the diagnosis of CNB,the sensitivity of d≥0.5 cm was better,and the accuracy of aspect ratio≤1 was higher(P<0.05).The cystic and solid nodules may affect the FNA diagnosis,and solid nodules had higher accuracy(P<0.05).Conclusion:CNB is more valuable in diagnosing thyroid gland nodules,but FNA is more sensitive for nodules less than 0.5 cm in diameter.