【摘要】 目的 探究超声引导下细针穿刺活检(US-FNA)联合液基细胞学(TCT)在甲状腺微小结节(TMN)临床检查中的应用价值。方法 分析2019年5月至2022年8月宜春市人民医院收治的97例TMN患者的临床资料,所有患者均行术前US-FNA取样,并分别进行传统涂片和TCT制片,以术后病理诊断为“金标准”,比较US-FNA联合传统涂片、TCT制片对TMN的诊断价值,分析甲状腺微小癌(TMC)、良性结节的超声特征差异。结果 97例患者中病理诊断良性结节68例,TMC结节29例。US-FNA联合传统涂片诊断良性结节63例,TMC结节34例,其中漏诊3例,误诊8例,诊断敏感度为89.66%,特异度为88.24%,准确率为88.65%,阳性预测值为76.47%,阴性预测值为95.24%,Kappa值为0.742。US-FNA联合TCT制片诊断良性结节64例,TMC结节33例,其中漏诊2例,误诊6例,诊断敏感度为93.10%,特异度为91.18%,准确率为91.75%,阳性预测值为81.82%,阴性预测值为96.88%,Kappa值为0.811,与病理诊断具有较高的一致性(Kappa值>0.75)。TMC组结节不规则形态、不清晰边界、低回声及Ⅱ～Ⅲ级血流占比高于良性结节组,差异有统计学意义(P<0.05);两组的结节质地比较,差异无统计学意义(P>0.05)。结论 US-FNA联合TCT制片对TMN的诊断价值略高于传统涂片,TMC结节超声检测具有明显特征性。更多还原

【Abstract】 Objective To explore the application value of ultrasound-guided fine needle aspiration(US-FNA) combined with thinprep cytologic test(TCT) in the clinical diagnosis of thyroid micronodules(TMN). Methods The clinical data of 97 TMN patients admitted to Yichun People’s Hospital from May 2019 to August 2022 were analyzed. All patients underwent preoperative US-FNA sampling, and traditional smear and TCT were made respectively. The postoperative pathological diagnosis was taken as the "gold standard" to compare the diagnostic value of US-FNA combined with traditional smear and TCT in TMN. The ultrasonic characteristics of thyroid micro carcinoma(TMC) and benign nodules were analyzed. Results Among 97 patients, 68 cases were pathologically diagnosed as benign nodules and 29 cases as TMC nodules. US-FNA combined with traditional smear correctly diagnosed 63 cases of benign nodules and 34 cases of TMC nodules, including 3 cases of missed diagnosis and 8 cases of misdiagnosis, and its diagnostic sensitivity, specificity, accuracy rate, positive predictive value, negative predictive value and Kappa value were 89.66%, 88.24%, 88.65%, 76.47%, 95.24% and 0.742,respectively. US-FNA combined with TCT smear-making correctly diagnosed 64 cases of benign nodules and 33 cases of TMC nodules, including 2 cases of missed diagnosis and 6 cases of misdiagnosis. The diagnostic sensitivity, specificity,accuracy rate, positive predictive value, negative predictive value and Kappa value of US-FNA combined with TCT smear-making were 93.10%, 91.18%, 91.75%, 81.82% 96.88% and 0.811, respectively, and it had high consistency with pathological diagnosis(Kappa value>0.75). The proportion of irregular shape, unclear boundary, low echo and Ⅱ-Ⅲ grade blood flow in TMC group were higher than those in benign group, and the differences were statistically significant(P<0.05).There was no significant difference in the texture of nodules between the two groups(P>0.05). Conclusion The diagnostic value of US-FNA combined with TCT smear-making on TMN is slightly higher than that of traditional smear. TMC nodules have obvious characteristics in ultrasound detection.更多还原