CAJ | 학술논문

目的通过对甲状腺恶性结节超声特征的筛选,探讨超声引导下细针穿刺细胞学检查对甲状腺结节术前评估的意义.方法回顾2010年12月-2011年8月首都医科大学附属北京同仁医院耳鼻咽喉-头颈外科进行超声检查、超声引导下细针穿刺细胞学检查并行手术治疗的39例甲状腺结节患者.将超声特征、细针穿刺细胞学结果与术后病理进行对照分析,筛选恶性结节的超声特征.结果超声引导下甲状腺结节细针穿刺细胞学的灵敏度为80.0％,特异度为89.4％,误诊率为11.0％,漏诊率为20.0％.甲状腺结节实性、纵横比≥1、钙化直径＜2mm、形态不规则、边界欠清、Ⅲ型血流等超声特征在恶性结节和良性结节中差异有统计学意义(P＜0.05).其中纵横比及形态的特异度较高,分别为90.5％及85.7％.但没有一个单独的超声特征集高灵敏度、高阳性预测值为一体可作为评估甲状腺恶性结节的指标.结论具备任意两项特异性超声特征的结节可作为高危恶性结节进行细针穿刺,可减少实施穿刺的例数.
목적 통과대갑상선악성결절초성특정적사선,탐토초성인도하세침천자세포학검사대갑상선결절술전평고적의의.방법 회고2010년12월-2011년8월수도의과대학부속북경동인의원이비인후-두경외과진행초성검사、초성인도하세침천자세포학검사병행수술치료적39례갑상선결절환자.장초성특정、세침천자세포학결과여술후병리진행대조분석,사선악성결절적초성특정.결과 초성인도하갑상선결절세침천자세포학적령민도위80.0％,특이도위89.4％,오진솔위11.0％,루진솔위20.0％.갑상선결절실성、종횡비≥1、개화직경＜2mm、형태불규칙、변계흠청、Ⅲ형혈류등초성특정재악성결절화량성결절중차이유통계학의의(P＜0.05).기중종횡비급형태적특이도교고,분별위90.5％급85.7％.단몰유일개단독적초성특정집고령민도、고양성예측치위일체가작위평고갑상선악성결절적지표.결론 구비임의량항특이성초성특정적결절가작위고위악성결절진행세침천자,가감소실시천자적례수.
Objective In this paper,we selected the ultrasound features of the malignant thyroid nodules to evaluate the preoperative diagnostic value of ultrasound-guided fine needle aspiration biopsy ( US-FNAB )in the preoperative evaluation of thyroid nodules.Methods Thirty-nine patients with thyroid nodules managed in the department of otolaryngology-head and neck surgery,Beijing Tongren Hospital,Captial Medical University from Dec.2010 to Aug.2011 were studied.All of them were undertaken the ultrasonic examination,ultrasound-guided fine needle aspiration biopsy and surgical treatment subsequently.The ultrasonic features,fine needle aspiration biopsy results and postoperative pathological results were analyzed to draw out the characteristics of sonographic features of thyroid malignant nodules.Results The sensitivity,specificity,misdiagnosis and missed diagnosis of fine needle aspiration biopsy were 80.0％,89.4％,11.0％ and 20.0％ respectively.Solid nodules,shape/dimension ratio ≥ 1,calcifications ＜ 2 mm,irregular shape,blurred margins,type Ⅲ vascularity were correlated significantly with the malignant nodules of thyroid.The specificity of shape to dimension ratio and outline of the nodules were relatively higher than others (90.5％and 85.7％ respectively).But there were no single ultrasound feature that could carry a high sensitivity and positive predictive value in the diagnosis of thyroid nodules.Conclusions Two ultrasonographic characteristics could be used together as a select indicator to screen malignant nodules which can reduce the chance of undertaking the fine needle aspiration biopsy in thyroid nodules.