甲状腺结节超声引导下细针穿刺标本诊断结合液基细胞块技术应用

Technology application of Ultrasound guided fine needle puncture specimen diagnosis of thyroid nodules combined with liquid-based cell block

目的探讨液基细胞块(liquid-based cytology cell block,LCB)技术在超声引导下甲状腺结节细针穿刺细胞学(fine needle aspiration cytology of thyroid nodules under ultrasound-guided,UG-TFNA)标本诊断中的应用价值。方法收集2019年6月—2022年6月南阳市中心医院甲状腺结节手术患者74例,其中术后确诊甲状腺恶性肿瘤52例(占总例数的70.27%)(包括乳头状癌papillary thyroid carcinoma,PTC 46例,占88.46%),所有患者均经术前超声引导下细针穿刺液基细胞涂片(liquid-based cytology cell smears,LCS)检查并制备液基细胞块石错切片诊断,疑难病例辅助细胞蜡块免疫组织化学染色(immunohistochemistry,IHC)。分析单纯LCS与液基细胞块联合液基细胞学(LCB and LCS,LCSCB)二者在甲状腺癌诊断中的准确性。数据经统计学处理,卡方检验。结果单纯LCS总报告异常细胞病例62例(83.78%),获肯定性恶性诊断38例(51.35%)(包括PTC36例),倾向恶性诊断16例(21.62%)。LCSCB总报告异常细胞病例57例(77.03%),获肯定性恶性诊断49例(66.22%)(包括PTC44例),恶性倾向性诊断5例(6.76%)。在甲状腺癌明确诊断率方面,LCSCB优于单纯LCS,差异具有显著性(P<0.05)。结论液基细胞块在甲状腺细针穿刺细胞学诊断中具有重要价值,液基细胞块联合液基细胞学涂片并辅以细胞块免疫组织化学染色对于液基细胞学涂片和细胞块微组织学中甲状腺癌形态学不典型的病例的确诊极为有益。

Objective To explore the application value of liquid-based cytology cell block(LCB)technique in the diagnosis of fine needle aspiration cytology of thyroid nodules(TFNA)under ultrasound-guided(UG).Methods Totally 74 patients with thyroid nodule operation in Nanyang Central Hospital from June 2019 to June 2022 were collected,among which 52 cases(70.27%of the total cases)were diagnosed postoperative thyroid malignant tumors(including 46 cases of papillary carcinoma,PTC,accounting for 88.46%).All patients were examined by ultrasound-guided fine needle aspiration Liquid-based cytology cell smears(LCS)before surgery and diagnosed with Liquid based cytology cell block(LCB).Immunohistochemistry(IHC)was performed in difficult cases.To analyze the accuracy of LCS alone and liquid-based cell blocks combined with liquid-based cytology(LCB and LCS,LCSCB)in the diagnosis of thyroid cancer.The data were statistically processed and Chi-square test was performed.Results There were 62 cases(83.78%)with abnormal cells in LCS alone,38 cases(51.35%)with positive malignant diagnosis(including 36 cases with PTC),and 16 cases(21.62%)with tendency to malignant diagnosis.LCSCB reported 57 cases(77.03%)of abnormal cells,49 cases(66.22%)of positive malignant diagnosis(including PTC44 cases),and 5 cases(6.76%)of malignant tendency diagnosis.LCSCB was superior to LCS alone in the definite diagnosis rate of thyroid cancer,and the difference was statistically significant(P<0.05).Conclusion Liquid-based cytology cell blocks are of great value in the diagnosis of thyroid fine needle puncture cytology.The combination of liquid cell blocks with liquid cell smear and cell block immunohistochemical staining is very beneficial for the diagnosis of thyroid carcinoma with atypical morphology in liquid cell smear and cell block microhistology.