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首页|期刊导航|中国普通外科杂志|细针穿刺细胞学检查与粗针穿刺活检术对甲状腺结节的诊断效能比较

细针穿刺细胞学检查与粗针穿刺活检术对甲状腺结节的诊断效能比较OA北大核心CSTPCD

Comparison of the diagnostic efficacy of fine-needle aspiration cytology and core needle biopsy for thyroid nodules

中文摘要英文摘要

背景与目的:彩超引导下细针穿刺细胞学检查(FNAC)是术前评估甲状腺结节良恶性的主要方法,其缺点是取材不足,可能导致误诊或漏诊.粗针穿刺活检术(CNB)可弥补FNAC的不足,但其缺点是增加了疼痛和创伤.因此,本研究比较FNAC与CNB对甲状腺结节诊断的诊断效能及各自特点,以期为临床合理选择提供参考. 方法:回顾性分析2020年11月-2022年11月于武汉大学中南医院接受甲状腺手术的552例患者资料,所有患者术前均接受超声检查,并依次行FNAC与CNB,穿刺1周内行患侧甲状腺切除术.收集患者临床资料及甲状腺结节的超声特征、术前细胞学、组织病理学及术后常规病理结果,以术后常规病理为金标准,分析FNAC及CNB诊断效能. 结果:总体上,FNAC与CNB对甲状腺结节诊断敏感度、特异度、准确率相近,差异均无统计学意义(88.7%vs.91.4%,P=0.283;90.6%vs.97.4%,P=0.226;85.3%vs.89.1%,P=0.058);对滤泡性肿瘤的良恶性判别,CNB优于FNAC(P=0.024).当结节直径≤2.0 cm时,FNAC与CNB诊断效能基本无差异;当结节直径>2.0 cm时,CNB的敏感度明显高于FNAC(95.0%vs.79.2%,P<0.001),联合二者诊断可进一步提高敏感度至99.2%.对于钙化结节、囊性变结节、富血供结节的诊断,CNB的敏感度与准确率均高于FNAC(91.0%vs.88.7%、91.0%vs.84.8%、92.8%vs.85.1%;93.2%vs.88.8%、91.7%vs.84.8%、93.3%vs.85.2%),除对钙化结节的差异无统计学意义外,其余差异均有统计学意义(均P<0.05);对于缺乏血供结节的诊断,FNAC 的敏感度与准确率均高于CNB(92.7%vs.90.2%,P=0.004;96.2%vs.90.5%,P=0.005). 结论:CNB与FNAC对直径≤2.0 cm的甲状腺结节的诊断效能相当,但CNB在滤泡性肿瘤的判别方面有一定优势.CNB对直径>2.0 cm、钙化结节、富血供及囊性或囊实性结节甲状腺结节诊断效能优于FNAC,对具备上述特征的结节联合FNAC与CNB检查可在一定程度上提高甲状腺结节术前诊断的准确率.

Background and Aims:Fine-needle aspiration cytology(FNAC)guided by ultrasound is the primary method for preoperative evaluation of thyroid nodules'benign or malignant nature.Its drawback is inadequate sampling,which may lead to misdiagnosis or missed diagnosis.Core needle biopsy(CNB)can compensate for the shortcomings of FNAC,but its disadvantages include increased pain and trauma.Therefore,this study compared the diagnostic efficacy and characteristics of FNAC and CNB to diagnose thyroid nodules,aiming to provide a reference for clinical rational selection. Methods:The data of 552 patients who underwent thyroid surgery in Zhongnan Hospital of Wuhan University from November 2020 to November 2022 were retrospectively analyzed.All patients underwent preoperative ultrasound examination and subsequent FNAC and CNB.Thyroidectomy on the affected side was performed within one week after the puncture.Clinical data of patients,ultrasound characteristics of thyroid nodules,preoperative cytology,histopathology,and postoperative routine pathology results were collected.Postoperative routine pathology was used as the gold standard to analyze the diagnostic efficacy of FNAC and CNB. Results:Overall,FNAC and CNB showed similar sensitivity,specificity,and accuracy in diagnosing thyroid nodules,with no statistically significant differences(88.7%vs.91.4%,P=0.283;90.6%vs.97.4%,P=0.226;85.3%vs.89.1%,P=0.058).CNB was superior to FNAC in distinguishing between benign and malignant follicular tumors(P=0.024).When the nodule diameter was ≤2.0 cm,there was generally no difference in diagnostic efficacy between FNAC and CNB.When the nodule diameter was>2.0 cm,the sensitivity of CNB was significantly higher than that of FNAC(95.0%vs.79.2%,P<0.01),and the combined diagnosis of both further increased the sensitivity to 99.2%.For the diagnosis of calcified nodules,cystic nodules,and nodules with rich vascularity,the sensitivity and accuracy of CNB were higher than those of FNAC(91.0%vs.88.7%,91.0%vs.84.8%,92.8%vs.85.1%;93.2%vs.88.8%,91.7%vs.84.8%,93.3%vs.85.2%),with statistically significant differences except for calcified nodules(all P<0.05).For the diagnosis of avascular nodules,the sensitivity and accuracy of FNAC were higher than those of CNB(92.7%vs.90.2%,P=0.004;96.2%vs.90.5%,P=0.005). Conclusion:CNB and FNAC have similar diagnostic efficacy for thyroid nodules with a diameter ≤2.0 cm,but CNB has certain advantages in distinguishing follicular tumors.CNB is more effective than FNAC for thyroid nodules with a diameter>2.0 cm,calcified nodules with rich vascularity,and cystic or solid nodules.Combining FNAC and CNB examinations for nodules with the above characteristics can improve the preoperative diagnostic accuracy of thyroid nodules to a certain extent.

袁芊芊;侯晋轩;李金朋;田文;吴高松

武汉大学中南医院甲状腺乳腺外科,湖北武汉 430071中国人民解放军总医院第一医学中心普通外科医学部甲状腺(疝)外科,北京 100853

临床医学

甲状腺结节活组织检查,细针活组织检查,粗针诊断,鉴别

Thyroid NoduleBiopsy,Fine-NeedleBiopsy,Large-Core NeedleDiagnosis,Differential

《中国普通外科杂志》 2024 (005)

772-779 / 8

湖北省卫生计生委联合基金资助项目(WJ2018H0014).

10.7659/j.issn.1005-6947.2024.05.010

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