超声引导下甲状腺结节细针穿刺细胞学检查的应用价值

发布时间：2019-01-17 07:41

【摘要】：目的：通过对大样本量甲状腺结节的细针穿刺细胞学检查结果及病理学结果分析，探讨二种不同穿刺方法的临床应用价值；甲状腺结节大小对穿刺细胞学检查的影响及穿刺细胞学检查对甲状腺结节良、恶性的诊断价值。方法：选取2011年5月-2014年2月于我院行甲状腺结节细针穿刺细胞学检查的2574例患者共3000个甲状腺结节。所有结节均经手术病理或穿刺活检病理证实。在3000个结节的穿刺过程中，采用目前常用的二种的穿刺方法进行随机分组，第一种无负压穿刺方法共1080个结节，第二种有负压穿刺方法共1920个结节；并根据结节大小，分成三组（结节1cm组，0.5cm结节1cm组，结节0.5cm组），结节1cm组692个，0.5cm结节1cm组1038个，结节0.5cm组1270个。对照分析3000个甲状腺结节细胞学及病理学结果，得出穿刺细胞学的准确性、敏感性、特异性、假阳性率、假阴性率，比较二种穿刺方法的准确性、敏感性、特异性、假阳性率、假阴性率。并比较根据结节大小分组的三组患者的准确性、敏感性、特异性、假阳性率、假阴性率。采用SPSS13.0统计软件分析数据，计数资料采用X2检验，以P0.05差异有统计学意义。结果：通过病理学诊断3000个结节中良性病变1179个：结节性甲状腺肿761个、甲状腺腺瘤409个、甲状腺炎209个。恶性病变1821个：甲状腺乳头状癌1802个、髓样癌11个、未分化癌4个、甲状腺滤泡状腺癌5个。细胞学穿刺成功2987个，13个因涂片不满意取材不成功。甲状腺结节良性病变1179个中，US-FNA诊断良性1061个、恶性14个、可疑恶性91个；涂片不满意13个。甲状腺结节恶性病变1821个中，US-FNA诊断恶性1421个、可疑恶性181个、良性219个。以病理学检查结果作为金标准，分析甲状腺结节细针穿刺细胞学检查的结果，其准确性、敏感性、特异性、假阳性率、假阴性率分别为88.77%、87.97%、89.99%、8.9%、12.03%。穿刺方式不同的二组中，无负压穿刺组准确性、敏感性、特异性、假阳性率、假阴性率分别为88.14%、88.41%、87.69%、11.06%、11.58%，有负压穿刺组准确性、敏感性、特异性、假阳性率、假阴性率分别为88.48%、87.18%、90.40%、8.58%、12.82%。经各项比较P均0.05，统计学无差异。以甲状腺结节大小分组的三组中，结节1cm组准确性、敏感性、特异性、假阳性率、假阴性率分别为96.53%、96.18%、97.07%、2.93%、3.82%。0.5cm结节1cm组准确性、敏感性、特异性、假阳性率、假阴性率分别为95.47%、95.54%、95.37%、3.90%、4.46%。结节0.5cm组准确性、敏感性、特异性、假阳性率、假阴性率分别为83.31%、80.88%、87.10%、10.89%、19.12%。结节1cm组与0.5cm结节1cm组，二组准确性、敏感性、特异性、假阳性率、假阴性率各项比较P均0.05，统计学无差异。0.5cm结节1cm组与结节0.5cm组，各项比较P均0.05，差异有统计学意义。3000个结节穿刺，有5个并发穿刺后出血，，无其它严重并发症，其中实性2个，囊实性3个。局部按压30分钟后，再次行彩色多普勒超声检查，均未见明显异常。结论：（1）二种甲状腺结节细针穿刺细胞学检查的方法，其准确性、敏感性、特异性、假阳性率、假阴性率经比较，P均0.05，统计学无差异。（2）甲状腺结节细针穿刺细胞学检查中，0.5cm结节1cm组与结节0.5cm组，二组准确性、敏感性、特异性、假阴性率比较，P均0.05，差异有统计学意义。（3）甲状腺结节穿刺细胞学检查对甲状腺结节良、恶性的鉴别准确性较高，为临床提供可靠的影像学诊断。
[Abstract]:Objective: To study the clinical application value of two different puncture methods by the results of the fine needle aspiration cytology and the pathological results of the large sample size thyroid nodules. Malignant diagnostic value. Methods: From May, 2011 to February, 2014, there were 3000 thyroid nodules in 2574 patients with thyroid nodule fine needle biopsy in our hospital. Section. All the nodules are subject to a pathology or a biopsy of a surgical pathology. Real. In the course of the puncture of 3000 nodules, two kinds of puncture methods are used for randomization. The first non-negative pressure puncture method has 1080 nodules, and the second has a negative pressure puncture method for 1920 nodules, and according to the size of the nodules, it is divided into three groups (the node 1cm group, 0. 5cm nodule, 1cm). Group (group, nodule: 0. 5 cm), node 1cm group, 692, 0. 5cm, 1 cm group, 1038, and nodule 0. 5cm, group 1270. The accuracy, sensitivity, specificity, false positive rate and false negative rate of the puncture cytology were obtained by comparing the cytology and the pathological results of 3000 thyroid nodules. The accuracy, sensitivity, specificity, false positive rate and false negative of the two kinds of puncture methods were compared. and comparing the accuracy, sensitivity, specificity, false positive rate, false negative, The data were analyzed by SPSS 13.0. The data of the data were analyzed by X2. The difference of the data was P0. 05. Results: There were 1179 benign lesions in the 3000 nodules by pathology: the nodular goiter 761, the thyroid adenoma 409 and the thyroiditis 2. 09. malignant lesions (1821): papillary carcinoma (1802), medullary carcinoma (11), undifferentiated carcinoma (4), thyroid follicular gland 5 cases of cancer, 2987 for cytologic puncture and 13 for the non-satisfactory results of the smear. Not successful. Among the 1179 benign lesions of the thyroid nodules, the US-FNA was diagnosed as benign 1061, malignant in 14, and the suspicious malignant was 91; the smear was not satisfactory. 13. Among the 1821 cases of malignant lesions of thyroid nodules, US-FNA was diagnosed as malignant in 1421 cases, and the suspicious malignant was 181 and benign. The accuracy, sensitivity, specificity, false positive rate and false negative rate were 88. 77%, 87. 97%, 89. 99%, 8. 9%, 12. The accuracy, sensitivity, specificity, false positive rate and false negative rate were 88. 14%, 88. 41%, 87. 69%, 11. 06%, 11. 58%, respectively. The accuracy, sensitivity, specificity, false positive rate and false negative rate of negative pressure puncture group were 88. 48%, 87. 18%, 90. 40%, 8. 58%, 12. 82%. All P-0.05, statistics There was no difference. The accuracy, sensitivity, specificity, false positive rate and false negative rate of the group were 90.53%, 90.18%, 97.07%, 2.93%, 3.82%, 0.5cm, and the false negative rate were 90.47% and 95% respectively in the three groups of the thyroid nodule size group. 54%, 95. 37%, 3. 90%, 4. The accuracy, sensitivity, specificity, false positive rate and false negative rate were 83.31%, 80.88%, 87.0% and 10.89%, respectively. The accuracy, the sensitivity, the specificity, the false positive rate and the false negative rate of the group with the nodules of 1 cm and 1 cm in the group of 0. 5 cm, the positive rate of false negative and the false negative rate were all 0. 05, the difference was no difference. There were 5 concurrent post-puncture bleeding, no other serious complications, 2 of which were real, and the bladder was solid. 3. After the local press for 30 minutes, the color Doppler ultrasonic examination was performed again, none of which was found. explicit exception Conclusion: (1) The accuracy, sensitivity, specificity, false positive rate and false negative rate of two kinds of thyroid nodules are compared. (2) The accuracy, sensitivity, specificity and false-negative rate of the 0. 5cm nodules in the thyroid nodule were compared with that in the 0. 5 cm group. (3) The accuracy of the cytological examination of thyroid nodules is high and the accuracy of the differential diagnosis of thyroid nodules is high.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R581;R445.1

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