摘要
目的:探讨甲状腺结节行超声引导下细针穿刺抽吸活检(US-FNAB)细胞病理学Bethesda Ⅰ类(不能诊断)标本的主要影响因素,旨在提升US-FNAB获取甲状腺结节标本的质量,提高病理诊断的准确性.方法:回顾性选取我院超声科行甲状腺结节US-FNAB患者 245 例,共 250 个结节,根据甲状腺细胞病理学Bethesda 报告系统(TBSRTC)分为 6 类,其中BethesdaⅠ类为非诊断性(38 个),Bethesda Ⅱ～Ⅵ类判定为标本可以诊断(212 个),比较结节最大直径、位置、边界、内部结构、回声类型、生长方式、钙化情况、血供情况及是否处于特殊部位、是否靠近前或后被膜、操作者是否用穿刺针抽吸细胞保存液冲刷针头,分析影响US-FNAB标本TBSRTC诊断Ⅰ类的影响因素.结果:甲状腺结节处于特殊部位(结节贴近颈动脉、气管两侧或食管)与非特殊部位、且在处于特殊部位的结节中,最大直径≤10 mm与最大直径＞10 mm结节间TBSRTC诊断Ⅰ类与Ⅱ～Ⅵ类间差异有统计学意义(P＜0.05);另外,在取样次数为 4～6 次的前提下,穿刺后穿刺针未抽吸液体与抽吸液体冲刷针头之间TBSRTC诊断Ⅰ类与Ⅱ～Ⅵ类差异有统计学意义(P＜0.05).结论:甲状腺结节贴近颈动脉、气管两侧或食管是TBSRTC诊断Ⅰ类的主要影响因素,且最大直径≤10 mm比最大直径＞10 mm结节更容易获得Bethesda Ⅰ类诊断;在取样次数相同的前提下,穿刺后穿刺针未抽吸液基瓶中细胞保存液冲刷针头也是TBSRTC诊断Ⅰ类的主要影响因素.
Abstract
Objective:To explore the main influencing factors of thyroid nodule ultrasound guided-fine needle aspiration biopsy(US-FNAB)cytopathology Bethesda Type Ⅰ(undiagnosable)specimens,with a view to improving the quality of thyroid nodule specimens obtained by US-FNAB and improving the accuracy of pathological diagnosis.Methods:A total of 250 thy-roid nodules in 245 patients with US-FNAB and according to The Bethesda System for Reporting Thyroid Cytopathology(TB-SRTC)divided into 6 categories,of which the Bethesda Ⅰ category without diagnostic availability and the Bethesda Ⅱ～Ⅵcategories were judged to be diagnosable,the maximum diameter,location,boundary,internal structure,internal echo,growth pattern,calcification,blood supply and whether it was in a special position,near the anterior or posterior capsule and whether the operator washes the needle with the liquid in the liquid-based bottle after the puncture were compared,the influencing factors of TBSRTC diagnosis Ⅰ category in US-FNAB specimens were analyzed.Results:The thyroid nodule was located at a specific site(adjacent to the carotid artery,trachea,or esophagus)and without located at a specific site,located at a specific site with the largest diameter≤10 mm and the largest diameter＞10 mm,there were significant difference between TBSRTC diagnosis Ⅰ and Ⅱ～Ⅵ category(P＜0.05).In addition,on the premise of 4～6 sampling times,washes the needle with the liq-uid and non-washes after the puncture was significant difference between TBSRTC diagnosis Ⅰ and Ⅱ～Ⅵ category(P＜0.05).Conclusion:In the diagnosis of TBSRTC Ⅰ category,the thyroid nodules proximity of the carotid artery,trachea,or esopha-gus is a major influencing factor,and the maximum diameter≤10 mm than the maximum diameter＞10 mm nodule was more readily obtained the Bethesda Ⅰ category.Under the condition of the same sampling times,non-washes the needle with the liquid after the puncture was also the main influencing factor.
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