| 摘要: |
| 目的：应用超声引导下对超声诊断结果TI-RADS分级4级以上的不同大小的甲状腺结节行细针穿刺活检（ultrasound-guided fine needle aspiration biopsy,US-FNAB），探讨结节尺寸大小对细针穿刺活检诊断效率的影响，旨在为如何准确选择甲状腺可疑恶性结节穿刺活检方式提供一定的指导价值。方法：选取2017年1月至2018年12月在我单位经手术病理证实的甲状腺患者332例（共342个结节），根据结节的最大超声测量径线将结节分为5组（A组：≤5 mm； B组：5.1mm-10.0mm；C组：10.1mm-15.0mm；D组：15.1mm-20.0mm；E组：>20.0mm），US-FNAB结果与最终手术病理结果进行对比分析。结果：手术病理结果中，254个结节为恶性，88个结节为良性。在A、B、C、D、E五组中，US-FNAB诊断的敏感性分别是61.9%、76.6%、89.8%、72.4%、62.7%(p=0.010 )，特异性分别是87.5%、 88.9%、78.9%、100.0%、91.2%(p=0.052)，准确性分别是69.0%、78.6%、87.2%、78.9%、74.1%(p=0.443)，阳性预测率分别是92.9%、97.3%、92.9%、100.0%、91.3%%( p=0.721)，阴性预测率分别是 46.7%、42.1%、71.4%、52.9%、62.0%(p= 0.120), 恶性率分别是81.6%、 83.9%、75.6%、76.3%、60.0%（p=0.005）。结论：按结节大小所进行的分组中，US-FNAB对各组的诊断的敏感性差异具有统计学意义，C组（10.1mm-15.0mm）甲状腺结节敏感性较其他各组高，A组（≤5 mm）和E组（>20.0mm）甲状腺结节敏感性较其他各组低。但特异性、阳性预测值及准确性各组间差异不具统计学意义。因此，通过此研究，我们建议对≤5 mm的小结节应行隔期重复US-FNAB，对>20.0mm的结节可行直接行粗针穿刺，对10.1mm-15.0mm的结节首选US-FNAB。 |
| 关键词: 超声引导，细针穿刺活检 甲状腺结节 诊断有效率 |
| DOI： |
| 投稿时间：2019-09-02修订日期：2019-11-30 |
| 基金项目:四川省教育厅自然科学重点项目：17ZA0186；川北医学院博士启动基金课题（CBY15-QD11）；南充市市校合作项目（NSMC20170431 |
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| Comparison of the diagnostic efficacy of US-guided fine-needle aspiration?biopsy of thyroid nodules in different size |
| Xie Yu,Yu Jinhong,Li Yang,Du Pingjie,Zuo Hui |
| (North Sichuan Medical College) |
| Abstract: |
| Objective: we aim to investigate the effect of the size of the nodules on the diagnostic efficiency of fine-needle aspiration biopsy (US-FNAB) by using ultrasound-guided guided percutaneous fine-needle aspiration biopsy (Thyroid nodule) with TI-RADS Grade ≥ 4. The purpose of this study is to provide some guidance for the selection of biopsy methods of suspicious malignant thyroid nodules. Materials and methods: 342 consecutive thyroid nodules from 332 patients between January 2017 and December 2018 were enrolled , the thyroid nodules are grouped according to largest diameter (group A, ≤5.0mm；group B, 5.1mm-10.0mm; group C，10.1mm-15.0mm; group D,15.1mm-20.0mm; group E，>20.0mm),US-FNAB results were compared with surgical pathological tissue sections and analyzed the diagnostic efficacy of US-FNAB results.RESULTS: The final surgical pathology confirmed that 254 nodules were malignant and 88 nodules were benign. Among the five groups A, B, C, Dand E , the sensitivity was 61.9%、76.6%、89.8%、72.4%、62.7%(p=0.010 ), specificity were 87.5%、 88.9%、78.9%、100.0%、91.2%(p=0.052) , and the accuracy was 69.0%、78.6%、87.2%、78.9%、74.1%(p=0.443), the positive predictive rates were 92.9%、97.3%、92.9%、100.0%、91.3%%( p=0.721), and the negative predictive rates were 46.7%、42.1%、71.4%、52.9%、62.0%(p= 0.120) . The malignant rates were 81.6%、83.9%、75.6%、76.3%、60.0%（p=0.005）. Conclusion: In all groups, The sensitivity of Group C (10.1 mm-15.0 mm) was higher than that of other groups , in Group A (≤5 mm) and Group E (＞20.0 mm) had lower Thyroid nodule sensitivity than other groups. However, there were no significant differences in specificity, positive predictive value and accuracy among groups. Therefore, we suggest that US-FNAB should be repeated at intervals for small nodules less than 5mm, the CNB (core needle biosy) is feasible for nodules > 20.0 mm, and US-FNAB should be the first choice for nodules less than 10.1 mm-15.0 mm. |
| Key words: Comparison of the diagnostic efficacy of US-guided fine-needle aspiration?biopsy of thyroid nodules in different size |
