【摘要】 目的 评估甲状腺细针穿刺针感对Bethesda Ⅲ类结节良恶性的预测价值。资料与方法 回顾性分析2018年7月—2021年3月在河北省人民医院行超声引导下甲状腺结节细针穿刺活检（FNA）并有手术病理的487例患者共562个结节。依据FNA时穿刺针有无阻力感、砂砾感将针感分为0、1、2级。观察上述结节的针感分级与结节良恶性之间的关系，分析针感分级预测99例FNA病理为Bethesda Ⅲ类甲状腺结节性质的敏感度、特异度、阳性预测值、阴性预测值、准确度及受试者工作特征曲线下面积。结果 良性结节共241个（42.88%），恶性结节共321个（57.12%），良、恶性结节针感分级差异有统计学意义（χ~2=170.94,P<0.001）。Bethesda Ⅲ类结节恶性率为31.31%(31/99),FNA针感分级在该类结节良、恶性中差异有统计学意义（χ~2=44.09,P<0.001）,FNA针感评估BethesdaⅢ类结节良恶性的曲线下面积为0.830(95%CI0.731～0.930)，预测良恶性的敏感度为74.19%，特异度为91.18%，准确度为85.86%，阳性预测值为79.31%，阴性预测值为88.57%。Bethesda Ⅲ类结节在针感0级时良性率为88.57%(62/70)，在针感1级和2级时恶性率分别为76.47%(13/17)和83.34%(10/12)。结论 甲状腺细针穿刺针感可协助FNA病理鉴别甲状腺结节的性质，可用于预测Bethesda Ⅲ类结节良恶性。更多还原

【Abstract】 Purpose To evaluate the predictive value of puncture feeling to thyroid in benign and malignant Bethesda Ⅲ nodules.Materials and Methods A total of 562 nodules in 487 patients undergoing fine-needle aspiration(FNA) and surgical pathology in Hebei General Hospital from July 2018 to March 2021 were retrospectively analyzed. According to the sense of resistance and gravel of the puncture needle during FNA, the puncture feeling was divided into 0, 1 and 2 grade. The relationship between the puncture feeling grading and benign or malignant nodules was observed. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, area under the curve of ROC of puncture feeling grading in predicting the nature of Bethesda Ⅲ thyroid nodules in 99 cases were analyzed. Results There were 241 benign nodules(42.88%) and 321 malignant nodules(57.12%). There was significant difference in puncture feeling grade between benign and malignant nodules(χ~2=170.94,P<0.001). The malignancy rate of Bethesda Ⅲ nodules was 31.31%(31/99) and there was significant difference in puncture feeling grade between benign and malignant nodules(χ~2=44.09, P<0.001). The area under the curve of benign and malignant Bethesda Ⅲ nodules assessed based on FNA puncture feeling was 0.830(95% CI 0.731-0.930), with a sensitivity of 74.19%,specificity of 91.18%, accuracy of 85.86%, positive predictive value of 79.31%, and negative predictive value of 88.57% for determining benign or malignant. When the puncture feeling level was 0, the benign rate of Bethesda Ⅲ nodules was 88.57%(62/70), in the sense of needle level 1 and level 2, the malignancy rate of Bethesda Ⅲ nodules were 76.47%(13/17) and 83.34%(10/12), respectively. Conclusion The puncture feeling can help FNA pathology identify the nature of thyroid nodules, especially for the prediction of benign or malignant Bethesda Ⅲ nodules.更多还原