B超引导下细针穿刺TCT、CS及两者联合对甲状腺结节良恶性的诊断价值比较

Comparison of diagnostic value of TCT,CS in B-ultrasound guided fine needle biopsy and combination of them for benign and malignant thyroid nodules

目的比较B超引导下细针穿刺液基薄层细胞学技术(TCT)、常规细胞涂片(CS)及两者联合对甲状腺结节良恶性的诊断价值。方法分析性研究。抽取2022年5月至2023年6月河南中医药大学第一附属医院收治的78例甲状腺结节患者作为本次研究对象。所有患者均接受B超引导下细针穿刺细胞学检查,同时进行CS、TCT制片。比较CS、TCT制片的标本质量和形态学特征;以术后病理检查结果为金标准,分析CS、TCT制片及两者联合对甲状腺结节良恶性的诊断价值。结果病理检查结果显示,78例甲状腺结节患者中,54例(69.23%)为良性结节,24例(30.77%)为恶性结节。与CS相比,TCT制片的标本质量更高。CS、TCT制片及两者联合检出结果与手术病理检查结果存在一致性(Kappa=0.657、0.815、0.909,P均<0.001)。CS、TCT制片诊断甲状腺结节良恶性的曲线下面积(AUC)分别为0.752、0.846,特异度分别92.59%、96.29%,灵敏度分别为70.83%、83.33%,阳性预测值分别为80.95%、90.91%,阴性预测值分别为87.72%、92.86%,准确率分别为85.90%、92.31%;两者联合诊断的AUC为0.905,特异度为98.15%,敏感度为91.67%,阳性预测值为95.65%,阴性预测值为96.36%,准确率为96.15%。结论CS联合TCT制片在B超引导下细针穿刺诊断甲状腺结节良恶性中具有较高的临床价值,可提高诊断准确率。

Objective To compare the diagnostic value of thinprep cytologic test(TCT),conventional cell smear(CS)in B-ultrasound guided fine needle biopsy,and combination of them for benign and malignant thyroid nodules.Methods Analytical research was adopted in this study.A total of 78 patients with thyroid nodules admitted to the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from May 2022 to June 2023 were selected as the research objects.All selected patients underwent B-ultrasound guided fine needle cytology examination;at the same time,CS and TCT slides were performed.The specimen quality and morphological characteristics of CS and TCT slides were compared.Using postoperative pathological examination results as the gold standard,the diagnostic value of CS slide,TCT slide,and combination of them for benign and malignant thyroid nodules were analyzed.Results Pathological examination results revealed that 54(69.23%)of the 78 patients with thyroid nodules were benign,and 24 cases(30.77%)were malignant.Compared with CS slide,the quality of specimens in TCT slide was higher.The detection results of CS,TCT and combination of them were consistent with surgical pathological examination(Kappa=0.657,0.815,0.909;all P<0.001).The area under the curve(AUC)for benign and malignant thyroid nodules diagnosed by CS and TCT were 0.752 and 0.846,the specificity of CS and TCT were 92.59%and 96.29%;the sensitivity of them were 70.83%and 83.33%,the positive predictive values were 80.95%and 90.91%,and the negative predictive values were 87.72%and 92.86%,respectively,the accuracy rates were 85.90%and 92.31%,respectively.The AUC of the combination of CS and TCT in diagnosis was 0.905,the specificity was 98.15%,the sensitivity was 91.67%,the positive predictive value was 95.65%,the negative predictive value was 96.36%,and the accuracy was 96.15%.Conclusions CS combined with TCT has high clinical value in the diagnosis of benign and malignant thyroid nodules by B-ultrasound guided fine needle biopsy,which can improve the diagnostic accuracy.