Endoscopic ultrasound-guided fine-needle aspiration cytology in pancreaticobiliary carcinomas:diagnostic efficacy of cell-block immunocyto-chemistry

BACKGROUND： Endoscopic ultrasound-guided fine-needle aspiration cytology was demonstrated to be a useful tool for the diagnosis and staging of pancreaticobiliary neoplastic le- sions. Nonetheless, the diagnostic value of this procedure may be limited by low cellularity of the specimen, contamination of intestinal cells and unfeasibility of ancillary immunocy- tochemical procedures. The present study was to evaluate its usefulness in the diagnosis of neoplastic lesions.

Diagnostic value of liquid-based cytology and smear cytology in pancreatic endoscopic ultrasound-guided fine needle aspiration: A meta-analysis

BACKGROUND Smear cytology(SC)using endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)is the established and traditional choice for diagnosing pancreatic lesions.Liquid-based cytology(LBC)is a novel alternative cytological method,however,the comparative diagnostic efficacy of LBC remains inconclusive.AIM To examine the diagnostic efficacy of LBC and SC for pancreatic specimens obtained through EUS-FNA via a systematic review and meta-analysis.METHODS A systematic literature search was performed using PubMed,EMBASE,the Cochrane Library,and Web of Science.The numbers of true positives,false positives,true negatives,and false negatives for each cytological test(LBC and CS)were extracted from the included studies.The pooled sensitivity and specificity and the area under the summary receiver operating characteristic curve(AUC)were calculated,and the AUC was compared by Tukey's multiple comparisons test.The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies II tool.RESULTS A total of 1656 patients in eight studies were included.The pooled sensitivity and specificity and the AUC for LBC were 0.76(95%CI:0.72-0.79),1.00(95%CI:0.98-1.00),and 0.9174,respectively,for diagnosing pancreatic lesions.The pooled estimates for SC were as follows:Sensitivity,0.68(95%CI:0.64-0.71);specificity,0.99(95%CI:0.96-100.00);and AUC,0.9714.Similarly,the corresponding values for LBC combined with SC were 0.87(95%CI:0.84-0.90),0.99(95%CI:0.96-1.00),and 0.9894.Tukey’s multiple comparisons test was used to compare the sensitivities and AUCs of the three diagnostic methods;statistically significant differences were found between the three methods,and LBC combined with SC was superior to both LBC(P<0.05)and SC(P<0.05).The pooled sensitivity and AUC did not change significantly in the sensitivity analysis.CONCLUSION LBC may be sensitive than SC in the cytological diagnosis of pancreatic lesions,however,the superior diagnostic performance of their combination emphasizes their integrated usage in the clinical evaluation of pancreatic lesions.

The diagnostic evaluation of fine needle aspiration cytology of thyroid and its clinical application

Objective:The aim of the study was to investigate the diagnostic value of fine needle aspiration cytology (FNAC) and its clinical application.Methods:From April 2009 to February 2011,thyroid FNAC were performed in a total of 186 patients with thyroid nodule or mass in our hospital and 78 of those 186 patients subsequently underwent thyroidectomy.The FNAC findings were compared with the results of the corresponding histological diagnosis.Results:The results of thyroid FNAC for 186 patients showed that,(1) 166 cases of benign lesions,the detection rate was 89.24% (166/186),including 96 cases of nodular colloid goiter (51.61%),28 cases of simple colloid goiter (15.05%),38 cases of Hashimoto's thyroiditis (HT) (20.43%) and 4 cases of thyroid adenoma (2.15%);(2) 4 cases of suspicious malignant lesion,the detection rate was 2.15% (4/186);(3) 16 cases of malignant tumor,the detection rate was 8.60% (16/186).Seventy eight patients including malignant (16),suspicious malignant (4),HT (20) and nodular colloid goiters (38) cases diagnosed by FNAC were performed operation with thyroidectomy and the postoperative histopathologic results showed that there were 2 cases HT combined thyroid papillary carcinoma in HT 20 cases by FNAC,15 cases of thyroid papillary carcinoma and 1 case of follicular carcinoma in 16 cases of malignant tumor by FNAC and 4 case of thyroid papillary carcinoma in 4 cases of suspicious malignant by FNAC.Conclusion:Thyroid FNAC is a valuable and reliable method for the diagnosis of the thyroid nodules or mass or even most diffuse thyroid diseases.Diagnosis of HT and thyroid papillary carcinoma can be made by thyroid FNAC.There was larger hint value for nodular colloid goiter and simple colloid goiter according to thyroid FNAC.

Liquid Based Cytology of Cell Remnants in Needles Used for Breast Fine Needle Aspiration

This study examined cells contained in needles used for the collection of breast fine needle aspirates for the detection of malignant cells trapped in the needles. Remnants of cells contained in 50 needles used for the collection of scanty breast fine needle aspirates were examined by the liquid based cytology technique and compared with the conventional cytological technique of specimens in the corresponding syringes. The breast specimens were collected with clean sterile needles attached to the syringes. Smears were made and stained by the conventional method. The needles were removed from the syringes and a fixative was withdrawn into the syringes and the syringes were recapped with the needles. The fixative containing the specimen was then completely discharged into a centrifuge tube through the needles and treated by the liquid based cytology technique. The study revealed that cells were found trapped in all the needles used for the collection of breast FNA. 6% of them were positive for malignancy, similar to results obtained in the conventional method. Needles used for the collection of breast FNA should be examined before malignancy is completely ruled out particularly in extremely scanty specimens with a clinical suspicion of malignancy.

Combined use of fine needle aspiration cytology and full field digital mammography in preoperative assessment of breast masses

Objective: To evaluate the accuracy of these two methods and focus on the analysis and management of the false-negative cases. Methods: Results of full field digital mammography (FFDM) and fine needle aspiration cytology (FNAC) were obtained and analyzed from a consecutive of 102 women with palpable breast masses, results were correlated with the histopathological findings. Results: Of the 102 cases, malignancy was confirmed in 43 cases (42.16%) by final pathological examination, the sensitivity and specificity of cancer detection with FNA cytology was 90.7% (39/43) and 89.8% (53/59), re- spectively, the whole accuracy was 90.2% (92/102), with a positive predictive value of 86.7% (39/45) and a negative predictive value of 93.0% (53/57). FFDM gave a sensitivity of 88.4% (38/43), specificity of 83.1% (49/59), and whole accuracy 85.3% (87/102), the positive predictive value and negative predictive value was 79.2% (38/48) and 90.7% (49/54), respectively. All the FNAC-negative cancer cases were suggestive of malignancy by FFDM findings, however, the benign cases which present as equivocal finding by FNA cytology, could not be ruled out the presence of malignancy. Conclusion: FNAC and FFDM both are accurate, effective and economical diagnostic modalities, combined use of these two methods can reduced the misdiag- nosis rate of breast masses.

Fine needle aspiration cytology of Wilms' tumor:a case report

Wilms' tumor is extremely rare.In this article,we reported one case diagnosed by fine needle aspiration cytology(FNAC) and pathology.A three and a half-year-old boy was admitted to hospital with abdominal pain for two days.CT scan showed a large mass in the region of the left kidney of the boy.FNAC was performed on the mass,and the cytologic specimen showed malignant cells suggestive of a Wilms' tumor.Histologic examination of the operative specimen after the left nephrectomy also revealed Wilms' tumor.

Comparison of cytological and histological preparations in the diagnosis of pancreatic malignancies using endoscopic ultrasoundguided fine needle aspiration

BACKGROUND:Endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) has become a crucial diagnostic technique for pancreatic malignancies.The specimen obtained by EUS-FNA can be prepared for either cytological or histological examinations.This study was to compare diagnostic performance of cytological and histological preparations using EUSFNA in the same lesions when pancreatic malignancies were suspected.METHODS:One hundred and eighteen patients who underwent EUS-FNA for suspected pancreatic malignancies were consecutively enrolled.All procedures were conducted by a single echoendoscopist under the same conditions.Four adequate preparations were obtained by 22-gauge needles with 20 to-and-fro movements for each pass.The 4 preparations included 2 cytological and 2 histological specimens.The pathologic reviews of all specimens were conducted independently by a single experienced cytopathologist.Sensitivity,specificity,and accuracy of the 2 preparations were compared.RESULTS:The enrolled patients consisted of 62 males(52.5%),with the mean age of 64.6±10.5 years.Surgery was performed in 23(19.5%) patients.One hundred and sixteen(98.3%) lesions were classified as malignant,while 2(1.7%) were benign.Sensitivity of cytology and histology were 87.9% and 81.9%,respectively,with no significant difference(P=0.190).Accuracy was also not significantly different.Cytological preparation was more sensitive when the size of lesion was <3 cm(86.7% vs 68.9%,P=0.033).CONCLUSIONS:Our results suggested that the diagnostic performances of cytological and histological preparations are not significantly different for the diagnosis of pancreatic malignancies.However,cytological preparation might be more sensitive for pancreatic lesions <3 cm.

Endoscopic ultrasound-guided fine-needle aspiration biopsy-Recent topics and technical tips

Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is a useful procedure that enables reliable pathological diagnoses of pancreatobiliary diseases, subepithelial lesions, and swollen lymph nodes. In recent years, a pathological diagnosis based on EUS-FNA has made it possible to provide accurate treatment methods not only in these fields, but also in respiratory organs and otorhinolaryngology. This review discusses the latest topics pertaining to EUS-FNA as well as procedural tips.

Endoscopic ultrasound guided fine needle aspiration and useful ancillary methods

The role of endoscopic ultrasound(EUS) in evaluating pancreatic pathology has been well documented from the beginning of its clinical use. High spatial resolution and the close proximity to the evaluated organs within the mediastinum and abdominal cavity allow detection of small focal lesions and precise tissue acquisition from suspected lesions within the reach of this method. Fine needle aspiration(FNA) is considered of additional value to EUS and is performed to obtain tissue diagnosis. Tissue acquisition from suspected lesions for cytological or histological analysis allows, not only the differentiation between malignant and non-malignant lesions, but, in most cases, also the accurate distinction between the various types of malignant lesions. It is well documented that the best results are achieved only if an adequate sample is obtained for further analysis, if the material is processed in an appropriate way, and if adequate ancillary methods are performed. This is a multi-step process and could be quite a challenge in some cases. In this article, we discuss the technical aspects of tissue acquisition by EUS-guided-FNA(EUS-FNA), as well as the role of an on-site cytopathologist, various means of specimen processing, and the selection of the appropriate ancillary method for providing an accurate tissue diagnosis and maximizing the yield of this method. The main goal of this review is to alert endosonographers, not only to the different possibilities of tissue acquisition, namely EUS-FNA, but also to bring to their attention the importance of proper sample processing in the evaluation of various lesions in the gastrointestinal tract and other accessible organs. All aspects of tissue acquisition(needles, suction, use of stylet, complications, etc.) have been well discussed lately. Adequate tissue samples enable comprehensive diagnoses, which answer the main clinical questions, thus enabling targeted therapy.

22-gauge core vs 22-gauge aspiration needle for endoscopic ultrasound-guided sampling of abdominal masses

AIM To compare the aspiration needle(AN) and core biopsy needle(PC) in endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) of abdominal masses.METHODS Consecutive patients referred for EUS-FNA were included in this prospective single-center trial. Each patient underwent a puncture of the lesion with both standard 22-gauge(G) AN(Echo Tip Ultra; Cook Medical, Bloomington, Indiana, United States) and the novel 22 G PC(Echo Tip Pro Core; Cook Medical, Bloomington, Indiana, United States) in a randomized fashion; histology was attempted in the PC group only. The main study endpoint was the overall diagnostic accuracy, including the contribution of histology to the final diagnosis. Secondary outcome measures included material adequacy, number of needle passes, and complications.RESULTS Fifty six consecutive patients(29 men; mean age 68 years) with pancreatic lesions(n = 38), lymphadenopathy(n = 13), submucosal tumors(n = 4), or others lesions(n = 1) underwent EUS-FNA using both of the needles in a randomized order. AN and PC reached similar overall results for diagnostic accuracy(AN: 88.9 vs PC: 96.1, P = 0.25), specimen adequacy(AN: 96.4% vs PC: 91.1%, P = 0.38), mean number of passes(AN: 1.5 vs PC: 1.7, P = 0.14), mean cellularity score(AN: 1.7 vs PC: 1.1, P = 0.058), and complications(none). A diagnosis on the basis of histology was achieved in the PC group in 36(64.3%) patients, and in 2 of those as the sole modality. In patients with available histology the mean cellularity score was higher for AN(AN: 1.7 vs PC: 1.0, P = 0.034); no other differences were of statistical significance.CONCLUSION Both needles achieved high overall diagnostic yields and similar performance characteristics for cytological diagnosis; histological analysis was only possible in 2/3 of cases with the new needle.

Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses

AIM： To evaluate the diagnostic accuracy of histological evaluation of pancreatic tissue samples obtained by a modified method for recovering and processing the endoscopic ultrasound （EUS）-guided fine needle aspiration （FNA） material in the differential diagnosis of pancreatic solid masses. METHODS： Sixty-two consecutive patients with pancreatic masses were prospectively studied. EUS was performed by the linear scanning Pentax FG-38UX echoendoscope. Three FNAs （22G needle） were carried out during each procedure. The materials obtained with first and second punctures were processed for cytological study. Haterials of the third puncture were recovered into 10% formol solution by careful injection of saline solution through the needle, and processed for histological study. RESULTS： Length of the core specimen obtained for histological analysis was 6.5±5.3 mm （range 1-22 mm）. Cytological and histological samples were considered as adequate in 51 （82.3%） and 52 cases （83.9%）, respectively. Overall sensitivity of both pancreatic cytology and histology for diagnosis of malignancy was 68.4%. Conbary to cytology, histology was able to diagnose tumours other than adenocarcinomas, and all cases of inflammatory masses. Combination of cytology and histology allowed obtaining an adequate sample in 56 cases （90.3%）, with a global sensitivity of 84.21%, specificity of 100% and an overall accuracy of 90.32%. The complication rate was 1.6%.CONCLUSION： Adequate pancreatic core specimens for histological examination can be obtained by EUS-guided FNA. This technique is mainly useful for the diagnosis of different types of pancreatic tumours and evaluation of benign diseases.

Endoscopic ultrasound guided fine needle tissue acquisition:Where we stand in 2013?

Since its introduction,endoscopic ultrasound(EUS)guided fine needle aspiration and fine needle biopsy have become an indispensable tool for the diagnosis of lesions within the gastrointestinal tract and surrounding organs.It has proved to be an effective diagnostic method with high accuracy and low complication rates.Several factors can influence the accuracy and the diagnostic yield of this procedure including experience of the endosonographer,availability of onsite cytopathology services,the method of cytopathology preparation,the location and physical characteristics of the lesion,sampling techniques and the type and size of the needle used.In this review we will outline the recent studies evaluating EUS-guided tissue acquisition and will provide practical recommendations to maximize tissue yield.

Is there a difference between 19G core biopsy needle and 22G core biopsy needle in diagnosing the correct etiology?——A meta-analysis and systematic review

AIM To compare the accuracy of endoscopic ultra-sonography(EUS) 19 G core biopsies and 22 G core biopsies in diagnosing the correct etiology for a solid mass.METHODS Articles were searched in Medline, Pub Med, and Ovid journals. Pooling was conducted by both fixed and random effects models. RESULTS Initial search identified 4460 reference articles for 19 G and 22 G, of these 670 relevant articles were selected and reviewed. Data was extracted from 6 studies for 19G(n = 289) and 16 studies for 22G(n = 592) which met the inclusion criteria. EUS 19 G core biopsies had a pooled sensitivity of 91.6%(95%CI: 87.1-95.0) and pooled specificity of 95.9%(95%CI: 88.6-99.2), whereas EUS 22 G had a pooled sensitivity of 83.3%(95%CI: 79.7-86.6) and pooled specificity of 64.3%(95%CI: 54.7-73.1). The positive likelihood ratio of EUS 19 G core biopsies was 9.08(95%CI: 1.12-73.66) and EUS 22 G core biopsies was 1.99(95%CI: 1.09-3.66).The negative likelihood ratio of EUS 19 G core biopsies was 0.12(95%CI: 0.07-0.24) and EUS 22 G core biopsies was 0.25(95%CI: 0.14-0.41). The diagnostic odds ratio was 84.74(95%CI: 18.31-392.26) for 19 G core biopsies and 10.55(95% CI: 3.29-33.87) for 22 G needles. CONCLUSION EUS 19 G core biopsies have an excellent diagnostic value and seem to be better than EUS 22 G biopsies in detecting the correct etiology for a solid mass.

人工智能技术与FNAC联合在甲状腺良恶性结节诊断中的应用价值分析

目的:探究人工智能技术联合细针吸取细胞学检查(FNAC)在甲状腺良恶性结节诊断中的应用价值。方法:选取2022年1月至2023年12月在我院进行诊治的128例甲状腺结节患者作为研究对象并记录所有患者的临床资料,采用多普勒超声诊断仪分别进行甲状腺超声人工智能检查、超声引导下加负压FNAC以及二者联合检查,完成后统计患者的病理学结果,人工智能检测将内置算法作为指导,观察病灶参数,对良性、恶性例数进行统计;分析对比单一检测与联合检测的检出率、准确度、灵敏度、特异度、阳性及阴性预测值,并进行受试者工作特征(ROC)曲线分析。结果:128例甲状腺结节患者中,病理学检测出有良性结节者44例(34.38%),恶性结节者84例(65.63%);FNAC检测出良性结节患者55例,恶性结节患者73例;人工智能检测出良性结节患者49例,恶性结节患者79例;联合检测出良性结节患者45例,恶性结节患者83例。在各检测方式阳性与阴性预测值结果中,FNAC检测阳性预测值为65.45%,阴性预测值为89.04%;人工智能检测阳性预测值为71.42%,阴性预测值为88.61%;联合检测阳性预测值为95.55%,阴性预测值为98.80%。采用预测值对识别诊断绘制ROC发现,FNAC检测AUC值为0.789、灵敏度81.82%、特异度78.91%、约登指数0.60;人工智能检测AUC值为0.784、灵敏度79.55%、特异度79.54%、约登指数0.59;联合检测的AUC值为0.985、灵敏度97.72%、特异度92.28%、约登指数0.90,提示在甲状腺良恶性结节诊断中,与单一检测相比,联合检测具有更高的诊断价值。结论:与单一检测相比,人工智能技术与FNAC相结合的检测方式在甲状腺良恶性结节诊断中的诊断效率更高,建议临床推广使用。

FNAC联合FNA-Tg检测在甲状腺乳头状癌颈侧区淋巴结转移中的诊断价值

目的探讨超声引导下细针穿刺细胞学检查(FNAC)联合细针穿刺洗脱液甲状腺球蛋白(FNA-Tg)在甲状腺乳头状癌(PTC)颈侧区淋巴结转移中的诊断价值。方法回顾性分析行颈侧区淋巴结清扫术的200例PTC患者的临床资料,术前超声评估颈侧区有可疑转移淋巴结236枚,术后病理证实转移性淋巴结178枚,非转移性淋巴结58枚,所有患者均行FNAC、FNA-Tg检查。以术后病理结果为金标准,比较FNAC、FNA-Tg、FNAC联合FNA-Tg的诊断结果及诊断效能。结果FNAC联合FNA-Tg诊断PTC颈侧区淋巴结转移的灵敏度、准确度、阴性预测值高于单一诊断方法,差异具有统计学意义(P<0.05)。结论FNAC与FNA-Tg检测方法在临床中能够用于诊断PTC颈侧区淋巴结转移,两者联合检测可以进一步提高诊断效能,值得推广及应用。

超声检查辅助CT或MRI评估放疗头颈癌患者颈部淋巴结肿大的研究

目的本研究旨在评估超声(US)加/不加细针吸取细胞学(FNAC)和计算机断层扫描(CT)/磁共振成像(MRI)评估接受放射治疗的头颈癌患者颈淋巴结病(LAP)的诊断性能。方法回顾性分析269名在2014年1月至2023年1月期间接受放射治疗(RT)或同期放化疗(CCRT)的头颈部癌症患者。诊断方法包括:(1)单纯CT/MRI;(2)CT/MRI结合放疗后超声预测模型;(3)CT/MRI联合US+FNAC。我们使用ROC曲线比较了它们的诊断性能。结果总共观察到141个(52%)恶性淋巴结和128个(48%)良性淋巴结。在诊断准确率方面,CT/MRI和US+FNAC联合检查的ROC曲线下面积最高(0.965),其次是联合CT/MRI和放疗后US预测模型(0.906)和单独CT/MRI(0.836)。结论在评估接受放射治疗的头颈部癌症患者的LAP时,在诊断复发或持续性结节疾病方面,在CT/MRI中添加US检查比单独CT/MRI更高的诊断性能。

国际标准化超细针穿刺甲状腺结节不同细胞学采集模式诊断率的比较

目的:评价甲状腺结节穿刺时不同留样顺序对细胞学诊断率的影响。方法:共入选591例甲状腺结节患者的613个甲状腺结节,所有甲状腺结节均行4针细针穿刺,分为两种模式进行。模式一:304个结节穿刺,前2针进行涂片细胞学检查,后2针再进行液基细胞学检查;模式二:309个结节穿刺,前2针进行液基细胞学检查,后2针再进行传统涂片细胞学制片。细胞病理医师采用盲法单独对每份样本进行读片。比较不同细胞学制片方法以及两种模式对细针穿刺诊断率的影响。结果:先液基后涂片的细胞学采集模式总体诊断率为82.2%,显著高于先涂片后液基的模式(74.7%)(P=0.023)。对于直径≥10 mm的结节来说,先液基后涂片的细胞学采集模式总体诊断率为83.2%,同样显著高于先涂片后液基模式的诊断率(75.4%)(P=0.048);同为前2针,单独液基方法诊断率为78.0%,显著高于单独涂片诊断率(63.8%)(P<0.001);对于直径≥10 mm的结节而言,单独液基诊断率为78.3%,亦显著高于单独涂片的诊断率(62.6%)(P<0.001)。结论:使用国际标准化超细针进行甲状腺细针穿刺,先液基再涂片的细胞学采集模式诊断率显著高于先涂片后液基的采集模式;如果仅以一种方式来收取细胞学标本,沉降式液基细胞采集制片的方法诊断率显著优于传统涂片制片方法。

SurePath沉降式液基细胞采集技术应用于甲状腺细针穿刺细胞学诊断的准确性评价

目的:评价SurePath沉降式液基细胞采集(SurePath-liquid based cytology,SurePath-LBC)技术应用于甲状腺细针穿刺细胞学病理诊断的准确性。方法:回顾性收集南京医科大学第一附属医院甲乳外科行手术治疗且有完整术前细胞病理和术后病理资料的患者共计352例(363个甲状腺结节)。术前均采用SurePath-LBC技术进行细胞学制片,并对比细胞病理诊断与手术病理。对其中264例同时进行了BRAFV600E突变检测。结果:细胞病理提示可疑恶性共计112例,110例可疑乳头状癌(pap-illary thyroid carcinoma,PTC),2例可疑髓样癌(medullary thyroid carcinoma,MTC)。110例可疑PTC最终手术病理确定为PTC 106例,不典型滤泡性腺瘤1例,滤泡状癌(follicular thyroid carcinoma,FTC)1例,恶性潜能未定的甲状腺高分化肿瘤2例,诊断一致率为96.4%;2例可疑MTC的病例最终手术病理均证实为MTC,一致率为100.0%。总体可疑恶性病例与手术病理吻合率为97.3%。细胞病理提示恶性的甲状腺结节共计211例(210例PTC,1例MTC),210例PTC中,手术病理证实为PTC 209例,另1例提示乳头状增生伴不典型增生,诊断一致率为99.5%;细胞学诊断为MTC的病例,手术病理也确定为MTC,一致率为100.0%。总体恶性病例与手术病理吻合率为99.5%。BRAFV600E在可疑恶性和恶性中的突变率分别为82.3%和95.5%。细胞学诊断为良性的结节共计7例,最终手术病理3例为结节性甲状腺肿,2例滤泡性肿瘤,2例PTC。不典型病变的结节共23例,其中TI-RADS 4B及以上19例,BRAFV600E突变率为62.5%(10/16),总体恶性率87.0%。无诊断的病例10例,BRAFV600E突变率为57.1%(4/7),总体恶性率为50.0%。结论:采用SurePath-LBC方法进行甲状腺细针穿刺标本制片,细胞病理学诊断为可疑恶性或恶性时与最终手术病理诊断有高度一致性,对于具体的恶性类别也有准确的提示作用,该技术对于甲状腺结节术前诊断具有非常重要的参考价值,值得进一步推广和应用。

高频彩色多普勒超声联合US-FNAC在甲状腺癌诊断中的应用价值

目的探讨高频彩色多普勒超声(HF-CDU)联合超声辅助下细针穿刺细胞学检查(US-FNAC)在甲状腺癌鉴别诊断中的应用价值。方法将2020年2月至2023年3月在安徽医科大学直属附属六安医院(六安市人民医院)收治的110例甲状腺结节患者纳入本次回顾性研究。患者均接受HF-CFU检查和US-FNAC检查,以术后病理检查结果为“金标准”,分析不同性质结节的高频彩色多普勒超声的影像学特征,比较HF-CDU检查和US-FNAC单独检测和二者联合检测在甲状腺癌诊断中的灵敏性、特异性、准确性、假阳性和假阴性。结果110例患者共计有133个甲状腺结节,术后病理检查结果显示,恶性结节占比58.65%(78/133),良性结节占比41.35%(55/133);单发结节占比80.00%(88/110),多发结节占比20.00%(22/110)。超声检查显示,恶性结节的主要特征是血流分布多、纵横比≥1、微小钙化、形态不规则、边界毛糙或模糊、内部低或极低回声。HF-CDU检查的灵敏性、特异性、准确度、假阳性率和假阴性率分别为85.90%、89.09%、87.22%、10.91%和14.10%;US-FNAC检查的分别为89.74%、92.73%、90.98%、7.27%、10.26%;联合检测的分别为96.15%、94.55%、95.49%、5.45%、3.85%,联合检测的灵敏性、特异性、准确性、假阳性和假阴性率均优于HF-CDU、US-FNAC单独检测。结论HF-CDU、US-FNAC联合检测可有效提高甲状腺癌的确诊率,能够为患者早诊断、早治疗、提高预后提供可靠的方法。

超声引导下细针吸取细胞病理学诊断甲状腺乳头状癌的临床研究

目的探讨超声引导下细针吸取细胞病理学诊断甲状腺乳头状癌的临床意义。方法针对超声检查直径小于1 cm,临床触诊阴性的甲状腺结节病例,行超声引导下细针吸取细胞病理学检查,并将细胞病理学结果与术后组织病理学结果及BRAF基因V600E突变(BRAF V600E)检测结果进行对比分析。结果511例患者中,细胞病理学结果显示取材失败20例,良性病变14例,可疑恶性230例,甲状腺乳头状癌242例,非霍奇金淋巴瘤2例,甲状腺髓样癌3例;组织病理学结果显示良性病例5例,甲状腺乳头状癌496例,甲状腺乳头状癌合并桥本甲状腺炎3例,非霍奇金淋巴瘤3例,甲状腺髓样癌4例。细胞病理学假阴性病例10例,无假阳性病例,细胞病理学与组织病理学诊断符合率为94.27%。结论超声引导下细针吸取细胞病理学检查对甲状腺乳头状癌具有较高的诊断正确率,可对临床触诊阴性的甲状腺肿块进行较准确的术前诊断,结合术后组织病理学及BRAF V600E检测结果,为后续治疗及随访策略提供指导。