细针穿刺活检及洗脱液检测在甲状腺癌颈淋巴结清扫决策中的应用研究

发布时间：2018-08-03 21:32

【摘要】：目的探讨超声引导下细针穿刺活检及洗脱液检测技术在甲状腺癌颈淋巴结清扫中的应用价值。方法回顾性分析吉林大学中日联谊医院甲状腺外科2013年1月至2017年5月初次手术的甲状腺乳头状癌病人资料,统计在术前行颈部淋巴结超声引导下细针穿刺细胞学(FNAC)检查及洗脱液甲状腺球蛋白(FNA-Tg)检测的病例,将该检测结果与术前超声诊断、术后石蜡病理学检查结果进行对比研究,并就该组病人的一些卫生经济学指标进行分析。结果入组病人9923例,其中经超声引导下联合FNAC和FNA-Tg检查(FNAC-Tg)评估2609例,经评估后行颈侧区淋巴结清扫术(侧清)254例,术后均行石蜡病理学检查。对于颈侧区淋巴结的诊断,超声和FNAC-Tg的诊断敏感度、特异度、准确率分别为67.57%vs.97.30%、71.01%vs.82.61%和68.38%vs.93.81%。穿刺病人无颈部血肿、术后感染及无针道转移发生。2013—2017年各年度手术病人平均住院日分别为7.9、7.3、7.0、6.5、6.3 d;侧清病人占同期比例分别为52.6%、34.2%、30.8%、14.7%、12.4%;侧清标本中淋巴结转移发生率分别为35.8%、67.1%、60.4%、78.0%、80.1%。结论 FNAC-Tg诊断甲状腺癌颈侧区淋巴结转移准确率高,可为侧清策略的制定提供有力的循证医学依据,有利于减少预防性侧清,节省医疗资源。
[Abstract]:Objective to evaluate the value of ultrasound guided fine needle biopsy and elution detection in neck lymph node dissection of thyroid carcinoma. Methods the data of patients with papillary thyroid carcinoma who underwent thyroid surgery from January 2013 to early May 2017 were retrospectively analyzed. The results of (FNAC) and FNA-Tg in cervical lymph nodes were compared with those of preoperative ultrasound diagnosis and postoperative paraffin pathological examination. Some health economic indicators of this group of patients were analyzed. Results 9923 patients were included in the study. 2609 cases were evaluated by ultrasound guided FNAC and FNA-Tg (FNAC-Tg) and 254 cases were treated with lateral neck lymph node dissection (lateral clearance). Paraffin wax pathological examination was performed after operation. The sensitivity, specificity and accuracy of ultrasonography and FNAC-Tg were 67.57% and 68.38%, respectively. There was no hematoma in the neck, the average hospitalization days of the patients with postoperative infection and metastasis without needle in every year from 2013 to 2017 were 7.9 卤7.3 / 7.0 / 6.5d and 6.5d, respectively; the proportion of the patients with lateral clearance was 52.60.42 / 30.8 / 14.712.4respectively; the incidence of lymph node metastasis was 35.87.1/ 67.1/ 60.4 / 78.0/ 80.1, respectively. Conclusion the accuracy of FNAC-Tg in the diagnosis of cervical lymph node metastasis in thyroid carcinoma is high, which can provide evidence based medical evidence for the formulation of lateral clearance strategy, which is helpful to reduce the preventive side clearance and save medical resources.
【作者单位】：吉林大学中日联谊医院甲状腺外科;吉林大学中日联谊医院病理科;
【基金】：基金项目:吉林省科技厅(No.20150622002JC) 吉林省发展和改革委员会(No.2014N150)
【分类号】：R736.1

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