【摘要】 目的：评价甲状腺结节穿刺时不同留样顺序对细胞学诊断率的影响。方法：共入选591例甲状腺结节患者的613个甲状腺结节，所有甲状腺结节均行4针细针穿刺，分为两种模式进行。模式一：304个结节穿刺，前2针进行涂片细胞学检查，后2针再进行液基细胞学检查；模式二：309个结节穿刺，前2针进行液基细胞学检查，后2针再进行传统涂片细胞学制片。细胞病理医师采用盲法单独对每份样本进行读片。比较不同细胞学制片方法以及两种模式对细针穿刺诊断率的影响。结果：先液基后涂片的细胞学采集模式总体诊断率为82.2%，显著高于先涂片后液基的模式（74.7%）(P=0.023)。对于直径≥10 mm的结节来说，先液基后涂片的细胞学采集模式总体诊断率为83.2%，同样显著高于先涂片后液基模式的诊断率（75.4%）(P=0.048)；同为前2针，单独液基方法诊断率为78.0%，显著高于单独涂片诊断率（63.8%）(P <0.001)；对于直径≥10 mm的结节而言，单独液基诊断率为78.3%，亦显著高于单独涂片的诊断率（62.6%）(P <0.001)。结论：使用国际标准化超细针进行甲状腺细针穿刺，先液基再涂片的细胞学采集模式诊断率显著高于先涂片后液基的采集模式；如果仅以一种方式来收取细胞学标本，沉降式液基细胞采集制片的方法诊断率显著优于传统涂片制片方法。更多还原

【Abstract】 Objective:To evaluate the effects of the two different models on diagnostic rates using different combinations of smear and liquid-based cytology during thyroid fine needle aspiration(FNA). Methods:We recruited 613 thyroid nodules from 591 patients with thyroid nodules. All thyroid nodules underwent four passes of FNA in two modes. Mode 1,304 nodules were aspirated with the first two passes for traditional smear,while the latter two passes using SurePath with liquid-based cytology. Mode 2,the other 309nodules were aspirated in the opposite sequence with the first two passes for liquid-based cytology,while the later two passes for traditional smear cytology. The cytopathologists read each slide blindly and separately. The diagnostic rates of each model were compared. Results:We found that the diagnostic rate of the mode 2 with the first two passes for liquid-based cytology using SurePath and the latter two passes for conventional smear was 82.2%,which was significantly higher than 74.7%(P=0.023)in the group of mode1 using the first two passes for conventional smear and the following two passes for liquid-based cytology using SurePath. For nodules larger or equal to 10 mm,the diagnostic rate of the mode 2 was 83.2%,which was also significantly higher than the diagnostic rate of75.4%(P=0.048)in the mode 1 group. The diagnostic rate of the first two passes using liquid-based cytology alone was 78.0%,which was significantly higher than 63.8%(P < 0.001)in the conventional smear group also using the first two passes. For nodules larger or equal to 10 mm,the diagnostic rate of liquid-based cytology in the first two passes alone was 78.3%,which was also significantly higher than 62.6%(P < 0.001)in the conventional smear group similarly using the first two passes. Conclusion:As for diagnostic rate,cytology sampling model using liquid-based preparation as the first two passes followed by later two passes using smear is superior to the model using the combination with opposite sequence. If only one sampling method is applied,liquid-based cytology method would yield higher diagnostic rate.更多还原