CAJ | 학술논문

目的探讨超声引导下细针穿刺细胞学(FNAB)在常规超声TI-RADS 4-6类甲状腺病变中的应用价值.方法回顾性分析行常规超声TI-RADS分类同时进行超声引导下FNAB的494例患者(共501个结节),筛选出TI-RADS 4-6类患者163例共168个结节,分为三组:Ⅰ组,TI-RADS 4A类;Ⅱ组,TI-RADS 4B类;Ⅲ组,TI-RADS 5-6类(6类中除去已经病理证实者).以手术病理为金标准,计算三组超声引导下FNAB诊断准确性、敏感性、特异性、阳性预测值,并绘制ROC曲线评价其应用价值.结果超声引导下FNAB的准确性、敏感性、特异性、阳性预测值Ⅰ组分别为74.4％、73.3％、75.0％、64.7％,Ⅱ组分别为83.9％、87.5％、71.4％、91.3％,Ⅲ组分别为89.3％、91.7％、75.0％、95.7％.超声引导下FNAB对Ⅰ组、Ⅱ组的阳性预测值高于TI-RADS分类标准,差异有统计学意义;对Ⅲ组的阳性预测值与TI-RADS分类标准相近,差异无统计学意义.结论联合应用TI-RADS分类标准与FNAB,可提高工、Ⅱ组的诊断准确率,降低Ⅲ组的穿刺率.
목적 탐토초성인도하세침천자세포학(FNAB)재상규초성TI-RADS 4-6류갑상선병변중적응용개치.방법 회고성분석행상규초성TI-RADS분류동시진행초성인도하FNAB적494례환자(공501개결절),사선출TI-RADS 4-6류환자163례공168개결절,분위삼조:Ⅰ조,TI-RADS 4A류;Ⅱ조,TI-RADS 4B류;Ⅲ조,TI-RADS 5-6류(6류중제거이경병리증실자).이수술병리위금표준,계산삼조초성인도하FNAB진단준학성、민감성、특이성、양성예측치,병회제ROC곡선평개기응용개치.결과 초성인도하FNAB적준학성、민감성、특이성、양성예측치Ⅰ조분별위74.4％、73.3％、75.0％、64.7％,Ⅱ조분별위83.9％、87.5％、71.4％、91.3％,Ⅲ조분별위89.3％、91.7％、75.0％、95.7％.초성인도하FNAB대Ⅰ조、Ⅱ조적양성예측치고우TI-RADS분류표준,차이유통계학의의;대Ⅲ조적양성예측치여TI-RADS분류표준상근,차이무통계학의의.결론 연합응용TI-RADS분류표준여FNAB,가제고공、Ⅱ조적진단준학솔,강저Ⅲ조적천자솔.
Objective To explore the application value of ultrasound-guided fine needle aspiration biopsy(FNAB) in diagnosing thyroid nodules of TI-RADS 4-6 categories.Methods A retrospective analysis was made on the pathologic data of 494 patients (totally 501 nodules) who underwent TI-RADS ultrasonographic stratification and ultrasound-guided FNAB.168 thyroid nodules of TI-RADS 4-6 categories were selected from 163 patients and classified into three groups:group T,TI-RADS 4A categories;group Ⅱ,TI-RADS 4B category; group Ⅲ,TI-RADS 5-6 category(the pathologically confirmed cases in category 6 had been removed).The ultimate pathologic findings were taken as golden standards to calculate the accuracy,sensitivity,specificity,positive predictive value of ultrasound-guided FNAB in the three groups.ROC curve was drawn to evaluate the diagnostic value of FNAB.Results The accuracy,sensitivity,specificity,positive predictive value of the ultrasound-guided FNAB in the three groups were listed as follows:group Ⅰ 74.4％,73.3％,75.0％,64.7％;group Ⅱ 83.9％,87.5％,71.4％,91.3％;group Ⅲ 89.3％,91.7 ％,75.0％,95.7 ％ respectively.The positive predictive values of the ultrasound-guided FNAB for group Ⅰ and group Ⅱ was higher than that of conventional TI-RADS classification criteria,so the difference was statistically significant; while the positive predictive values for group Ⅲ was close to the conventional ultrasound TI-RADS classification criteria,the difference was not statistically significant.Conclusions The combination application of TI-RADS classification criteria and FNAB can improve the accuracy of ultrasound diagnosis in group Ⅰ and group Ⅱ,and reduce the puncture rate of group Ⅲ.