甲狀腺細針穿刺細胞學檢查在甲狀腺結節診斷中的應用價值

陳英銀+劉裕

[摘要]目的 探討細針穿刺細胞學檢查用于甲狀腺結節診斷的準確性。方法 回顧性分析我院2014年6月～2016年9月收治的86例甲狀腺結節患者，患者先行細針穿刺細胞學檢查，后手術切除病變組織進行病理學檢查，并以組織病理學檢查結果為金標準，觀察細針穿刺細胞學檢查的疾病檢出率，分析細胞學檢查用于甲狀腺結節診斷的敏感性、特異性。結果 以組織病理學檢查結果為標準，細針穿刺細胞學檢查疾病的特異性為89.8%，準確率為88.4%，敏感性為88.9%；細針穿刺細胞學檢查甲狀腺腫的檢出率為98.0%、髓樣癌為100.0%，乳頭狀癌檢出率為88.5%，濾泡性腺瘤檢出率最低，僅為25.0%。結論 甲狀腺結節者以細針穿刺細胞學檢查診斷，除了對濾泡性病變檢出率較低外，其他類型均有較高檢出率，此種檢查方式對多數甲狀腺結節具有較高診斷價值。

[關鍵詞]甲狀腺結節；細胞學檢查；診斷；病理學檢查

[中圖分類號] R581.9 [文獻標識碼] A [文章編號] 1674-4721（2017）08（c）-0054-03

[Abstract]Objective To explore the accuracy of fine needle aspiration cytology in the diagnosis of thyroid nodules.Methods The clinical data of 86 patients with thyroid nodules from June 2014 to September 2016 in our hospital were analyzed retrospectively.The patients were carried out fine needle aspiration cytology examination firstly and then pathological examination were carried out among surgical excision of diseased tissue.The pathological examination results were taken as the gold standard.Disease detection rate was observed by fine needle aspiration cytology and the sensitivity and specificity in the diagnosis of thyroid nodule by cytology examination were analyzed.Results The inspection results of histopathological examination were taken as standard.The specificity，the accuracy rate and the sensitivity rate of fine needle aspiration in testing the disease was 89.8%，88.4% and 88.9% respectively.The detection rate of the disease that the relevance ratio of goiter，carcinoma spongiosum and papillocarcinoma were 98.0%，100.0% and 88.5% respectively by fine needle aspiration examination but the relevance ratio of follicular adenoma was only 25.0%.Conclusion Other than the lower relevance ratio of follicular lesion，the relevance ratio is high by the adoption of fine needle aspiration cytologic examination and diagnosis for patients with other types of thyroid nodule so that it′s of higher diagnostic value.

[Key words]Thyroid nodule；Cytologic examination；Diagnosis；Pathological examination

甲狀腺結節是臨床常見疾病，中年、女性為疾病高發年齡段及性別，致病因素包括自身免疫、甲狀腺退行性變、炎癥等，近幾年臨床多以超聲對疾病進行診斷，檢出率為19%～67%，其中惡性病變占5%左右[1]。鑒于甲狀腺癌起病隱匿，早期患者體征、癥狀與良性結節相似，超聲無法準確區分結節性質，造成部分患者進行不必要手術只為了明確疾病性質，這不僅對患者創傷較大且增加了治療費用[2]。有學者提出穿刺細胞學檢查具有經濟、準確率高、創傷小、結果得到迅速等優點，用于甲狀腺結節診斷，能有效區分結節性質[3]。……