Diagnostic value of ultrasound-guided fine needle aspiration for papillary thyrid carcinoma
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摘要:
目的 探讨超声引导下甲状腺细针穿刺（US-FNAC）对甲状腺乳头状癌的诊断价值。 方法 选取2015年1月~2022年3月于我院甲状腺外科行甲状腺结节检查患者235例作为研究对象，根据结节最大径将其分为4组：A组（< 5 mm）、B组（5.1~10 mm）、C组（10.1~20 mm）、D组（≥20 mm）。以病理结果为金标准，统计并记录4组US-FNAC阳性率、无法确诊率、准确率、阳性预测值、阴性预测值、转移性结节分区情况。 结果 US-FNAC检查显示，随着结节直径的增加，4组阳性率不断提高（29.41%、39.50%、41.51%、61.82%），总阳性率为42.45%，各组间阳性病例的差异有统计学意义（χ2=12.180，P=0.007）；4组结节US-FNAC细胞学检查总的无法确诊率为1.80%，随着结节增大波动降低（1.96%、2.52%、1.89%、0.00%），各组间差异无统计学意义（χ2= 1.370，P=0.713）；US-FNAC细胞学检查结果显示，4组总准确率（符合率）为95.32%，随结节直径的增加有所波动，但差异无统计学意义（χ2=0.40，P=0.941）；4组结节总阳性预测值达到94.92%，总阴性预测值比阳性预测值略高，为95.63%，总敏感度、总特异性分别为94.12%、96.23%。195个转移结节中，超声分区定位检查与病理检查结果符合率分别为95.45%、98.11%、86.21%、97.89%。 结论 US-FNAC细胞学检查诊断甲状腺乳头状癌阳性率受到结节尺寸的影响，但对于准确性、阳性预测值、阴性预测值的影响不大。 Abstract:Objective To investigate the diagnostic value of ultrasound-guided fine needle aspiration (US-FNAC) for papillary thyroid carcinoma. Methods The data of 235 patients with thyroid nodules examined in our hospital from January 2015 to March 2022 were selected. According to the maximum diameter of nodules, they were divided into four groups: group A (< 5 mm), group B (5.1-10 mm), group C (10.1-20 mm) and group D (≥20 mm). The pathological results were taken as the gold standard, and the positive rate of US- FNAC, undiagnosed rate, accuracy rate, positive predictive value, negative predictive value, and partition of metastatic nodules in four groups were recorded. Results US-FNAC examination showed that with the increase of nodule diameter, the positive rates of the four groups were continuously increased (29.41%, 39.50%, 41.51%, 61.82%), and the total positive rate was 42.45%. The difference in positive cases between groups was statistically significant (χ2=12.180, P=0.007). The total undiagnosed rate of US-FNAC cytology in the four groups was 1.80%, and the fluctuation decreased with the increase of nodules (1.96%, 2.52%, 1.89%, 0.00%). There was no significant difference between the four groups (χ2=1.370, P=0.713). The results of US-FNAC cytological examination showed that the total accuracy (coincidence rate) of the four groups was 95.32%, which fluctuated with the increase of nodule diameter, but the difference was not statistically significant (χ2=0.40, P=0.941). The total positive predictive value of the four groups of nodules reached 94.92%, and the total negative predictive value was slightly higher than the positive predictive value, which was 95.63%. The total sensitivity and total specificity were 94.12% and 96.23%, respectively. Among the 195 metastatic nodules, the coincidence rates of ultrasound regional localization and pathological examination were 95.45%, 98.11%, 86.21% and 97.89%, respectively. Conclusion The positive rate of US- FNAC cytology in the diagnosis of papillary thyroid carcinoma is affected by nodule size, but has little effect on accuracy, positive predictive value and negative predictive value. -
Key words:
- ultrasound guidance /
- thyroid /
- fine needle puncture /
- papillary thyroid carcinoma
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图 1 甲状腺左侧叶及峡部结节穿刺涂片(HE, ×200)
患者男, 39岁, 病理诊断为甲状腺乳头状癌.
Figure 1. Puncture smear of thyroid nodules in left lobe and isthmus (HE, ×200).
表 1 US-FNAC细胞学检查结果比较
Table 1. Comparison of US-FNAC cytology results (n)
组别 总数 阳性 阴性 无法确诊 阳性率（%） A组 51 15 35 1 29.41 B组 119 47 69 3 39.50 C组 53 22 30 1 41.51 D组 55 34 21 0 61.82 总数 278 118 155 5 42.45 US-FNAC: 超声引导下甲状腺细针穿刺. A组：直径 < 5 mm, B组: 5.1 mm≤直径 < 10 mm, C组: 10.1 mm≤直径 < 20 mm, D组: 直径≥20 mm. 
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表 2 US-FNAC细胞学结果无法确诊率统计
Table 2. Undiagnosed rate statistics of US-FNAC cytology results (n)
组别 确诊数 无法确诊数 总数 无法确诊率（%） A组 50 1 51 1.96 B组 116 3 119 2.52 C组 52 1 53 1.89 D组 55 0 55 0.00 总数 273 5 278 1.80
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表 3 US-FNAC细胞学结果与病理诊断结果的符合程度
Table 3. The coincidence degree between US-FNAC cytological results and pathological diagnosis results
组别 总数（n） 符合（n） 不符合（n） 准确率（%） 阳性预测值（%） 阴性预测值（%） 敏感度（%） 特异性（%） A组 51 48 3 94.12 94.44 93.33 87.50 97.14 B组 119 114 5 95.80 95.74 95.83 93.75 97.18 C组 53 51 2 94.34 90.91 96.77 95.24 93.75 D组 55 52 3 94.55 97.06 90.48 94.29 95.00 总数 278 265 13 95.32 94.92 95.63 94.12 96.23
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表 4 超声结节分区定位与病理对照
Table 4. Ultrasonic nodule localization and pathological comparison
结节分区 Ⅱ区 Ⅲ区 Ⅳ区 Ⅵ区 总数 US-FNAC（n） 21 52 29 93 195 病理结果（n） 22 53 25 95 195 符合率（%） 95.45 98.11 86.21 97.89 -
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