细针穿刺细胞学检查在甲状腺癌碘-131 治疗后复发诊断中的应用价值

目的 评价甲状腺癌术后碘-131治疗的疗效,并探究超声引导下细针穿刺细胞学检查在碘-131治疗后复发病例诊断中的应用价值。方法 选择2011年1月～2018年5月期间甲状腺癌术后在北京大学深圳医院接受放射性碘治疗的474例患者进行随访,采用影像学检查筛选甲状腺癌患者的复发情况,并对这部分患者进行细针穿刺细胞学检测以评价细针穿刺细胞学在甲状腺癌复发患者中的诊断学价值。结果 474例甲状腺癌患者在接受碘-131治疗后,定期超声影像学筛查,筛查出甲状腺癌复发患者56例,超声影像学诊断筛查出甲状腺癌患者复发率为11.81%,对可疑复发的患者行细针穿刺细胞学检查及组织病理学检查,细针穿刺细胞学检查筛查出甲状腺癌复发患者50例,组织病理学检查证实甲状腺癌复发患者50例,经病理学修正后碘-131治疗后甲状腺癌患者复发率为10.55%,超声影像学检查对甲状腺癌患者复发诊断的符合率89.29%,细针穿刺细胞学诊断复发符合率为100%。结论 超声影像学检查是甲状腺癌患者常规使用的复查手段,而对于超声检查发现的可疑淋巴结进行超声引导下细针穿刺细胞学检查的准确率优于单纯的超声影像学检查。     

超声造影联合细针穿刺在甲状腺结节诊断中的意义

目的探讨超声造影联合细针穿刺在甲状腺结节诊断中的意义。方法 26例甲状腺结节术前常规二维及彩色多普勒超声检查后,行超声造影检查。观察造影剂开始显影、达峰及消退的全过程。并用ACQ软件进行时间-强度曲线分析。同时所有结节行超声引导下的细针穿刺(FNAC),细胞病理学检查。结果结合超声造影和细针穿刺的结果,与术后常规病理相比较,甲状腺良性结节诊断准确率94.6%,恶性结节诊断准确率100%。结论超声造影联合细针穿刺对甲状腺结节良恶性的鉴别提供了更多的信息,明显提高了术前的诊断准确率。     

超声引导下胸膜腔内肿块穿刺活检的临床应用

目的探讨超声引导下对胸膜腔内肿块作细胞学和组织学检查的穿刺方法及其临床价值。方法经超声或CT或/和MRI发现的88例94个胸膜腔内肿块,在超声引导下穿刺作细胞学检查和组织学活检,单一作细胞学穿刺的30个肿块,单一作组织学穿刺的64个肿块,其中36个肿块在作组织学穿刺检查的同时作细胞学穿刺检查。结果本组58个肿块作细胞学检查和组织学检查的病理阳性率为91.37%,36个肿块同时作细胞学检查和组织学检查的病理阳性率为97.22%。结论(1)超声引导下胸膜腔内肿块穿刺作细胞学和组织学检查方法简便、易行、直观,并发症少;(2)若对肿块穿刺同时作细胞学和组织学检查可明显提高病理的阳性率和穿刺的成功率,该项技术具有重要的临床价值。     

多模态超声对提高甲状腺结节细针穿刺活检取材成功率的价值

目的探讨多模态超声技术在引导甲状腺结节细针穿刺抽吸（FNA）细胞学检查中的应用及对提高取材成功率的价值。 方法选取2018年1月至2019年12月在中山大学附属第八医院超声医学科发现甲状腺结节,拟进行超声引导下FNA的患者308例,共316个结节。依据不同的FNA超声引导方式将其分为常规超声引导下FNA（US-FNA）组81个、超声造影引导下FNA（CEUS-FNA）组78个、超声弹性成像引导下FNA（UE-FNA）组78个和常规超声、超声造影、超声弹性成像联合的多模态超声引导下FNA（Multi-modality-FNA）组79个。FNA病理结果按照Bethesda报告系统进行分类。分析4组结节的FNA病理结果,并比较不同超声引导方法的取材成功率。 结果316个甲状腺结节FNA病理结果的Bethesda分类中：Ⅰ类为10.1%（32/316）;Ⅱ类为46.8%（148/316）;Ⅲ类为16.8%（53/316）;Ⅳ类为3.2%（10/316）;Ⅴ类为9.2%（29/316）;Ⅵ类为13.9%（44/316）。Multi-modality-FNA组、UE-FNA组、CEUS-FNA组和US-FNA组的取材成功率依次为：92.4%（73/79）、75.6%（59/78）、71.8%（56/78）、53.1%（43/81）。Multi-modality-FNA组的取材成功率高于其他各组,4组间比较差异有统计学意义（χ²=31.797,P＜0.001）,组间两两比较,Multi-modality-FNA组的取材成功率高于其他3组（P均＜0.008）。 结论多模态超声技术引导甲状腺结节FNA,有助于更精准地定位结节中恶性靶区域,从而提高取材成功率以及降低诊断不明确的结节所占的比例,值得在临床工作中开展。     

超声引导下甲状腺结节细针穿刺标本满意率影响因素分析

目的探讨超声引导下甲状腺结节细针穿刺标本满意率的影响因素。方法分析960例甲状腺患者1114个结节的细针穿刺活检(FNAB)结果,将标本分为满意和不满意两组,评估甲状腺结节穿刺针类型、超声特征、穿刺针次数及操作者经验对细针穿刺标本满意率的影响。结果22、23G针穿刺标本满意率最高(93.4%)、5ml注射器针头最低(87.3%),差异有统计学意义(P<0.05);结节不同大小、回声及有无钙化的标本满意率比较差异无统计学意义(P>0.05)。穿刺针次数之间标本满意率比较差异无统计学意义(P>0.05)。操作熟练组穿刺标本满意率最高(93.8%)、操作不熟练组最低(89.3%),差异有统计学意义(P<0.05)。结论穿刺针类型及操作者经验是影响甲状腺结节US-FNAB标本满意率的重要因素。     

薄层液基细胞学涂片在超声引导下甲状腺细针抽吸活检的应用简

目的探讨薄层液基细胞学涂片技术在超声引导下甲状腺穿刺中的应用价值。方法2008年1月至7月57例患者的57个甲状腺病变进行超声引导下细针抽吸细胞学检查并同时进行薄层液基细胞学涂片。其中14例获得手术病理,其余病例全部进行临床随访,随访时间5年至5年6个月。细胞学及组织学诊断结果分为四类：良性、恶性、可疑恶性及涂片不满意,将其与手术病理及临床随访结果进行对照分析,分析薄层液基细胞学涂片的细胞学特征及对甲状腺结节的诊断价值。结果薄层液基细胞学涂片与常规细胞学涂片特征有一定差异,主要表现在背景血细胞明显减少、细胞量较多、集中,胶质量少或浓集、核较深染、细胞皱缩更常见、常见细胞质碎片及裸核。57个甲状腺病变中,经手术病理及临床随访证实恶性6个,良性51个。薄层液基细胞学涂片诊断良性48个（84．2％）,恶性4个（7．0％）,涂片不满意5个（8．8％）。该技术诊断甲状腺恶性结节的敏感性66．7％,特异性100％,准确率94．5％,阳性预测值100％,阴性预测值96．2％。与常规细胞学涂片诊断结果相似。结论薄层液基细胞学涂片细胞学特征与常规涂片有一定差异,诊断准确性与常规涂片相似,在甲状腺结节细针抽吸细胞学检查中有较好的应用价值。     

21G和23G细针对超声引导下甲状腺结节穿刺标本满意率的比较

目的比较21G和23G型号细针对甲状腺结节穿刺标本的满意率。 方法2015年1月至2015年2月到首都医科大学附属友谊医院超声医学科进行甲状腺穿刺的病例共123例,123个结节中每个结节分别用21G和23G针进行超声引导下细针穿刺抽吸活组织检查（US-FNAB）,所有标本进行液基细胞学制片,将标本分为满意和不满意2种,21G和23G针穿刺的先后顺序按照随机表进行,比较21G细针和23G细针在进行甲状腺结节穿刺时标本的满意率。 结果21G针穿刺甲状腺结节的标本满意率87.8%（108/123）,23G针穿刺甲状腺结节的标本满意率86.2%（106/123）。差异无统计学意义（χ²=0.045,P>0.05）。 结论23G细针和21G细针在甲状腺结节穿刺中取得标本的满意率相近,23G细针穿刺可以作为一种方法用于临床工作。     

Nonsurgical management of thyroid abscess with sonographically guided fine needle aspiration

Treatment of thyroid abscess commonly includes the surgical drainage along with systemic antibiotic therapy. Alternatives for open surgical intervention may be the conservative management with use needle aspiration or catheter drainage. We report here two cases of thyroid abscess treatment with 21-gauge needle aspiration under ultrasound guidance. In each case needle drainage was performed twice, at the 1st and 5th day of admission. Antibiotics were administered in pills and injected into the abscess cavity followed the pus aspiration and lavage. Both patients were cured. Follow-up has not revealed recurrence during 6 month and 5 years.     

超声引导细针穿刺抽吸细胞学用于甲状腺结节的鉴别诊断

目的评价超声引导下细针穿刺细胞学检查（FNAC）在甲状腺结节鉴别诊断中的作用。方法本组患者76例．共84个结节，在超声引导下，用21G细针穿刺进行负压抽吸行细胞学检查。结果84个结节作出诊断的为77个，其中8个为恶性，69个为良性病变，7个未能作出诊断。结论超声引导下FNAC操作简便快捷且安全，准确性高，是甲状腺结节鉴别诊断可靠的方法之一。     

超声引导下细针穿刺细胞学检查在妇科盆腔肿瘤诊治中的应用

目的:探讨超声引导下细针穿刺细胞学(fine needle aspiration,FNA)检查对妇科盆腔肿瘤的临床诊断与治疗价值。方法:32例妇科盆腔肿瘤患者在B超引导下进行FNA检查,同时送组织病理学检查。结果:32例盆腔肿瘤患者中,FNA检查诊断为卵巢恶性肿瘤28例,盆腔良性病变4例。FNA诊断为恶性肿瘤的28例患者中,除3例因针吸样本量较少未能作出组织病理学诊断外,余25例组织病理学诊断为浆液性、黏液性、乳头状癌或子宫内膜样腺癌等。FNA诊断为良性肿瘤的4例患者中,术后组织病理学证实为卵巢畸胎瘤、卵巢浆液性囊腺瘤、子宫肌瘤、附件炎性反应。FNA检查对盆腔肿物诊断的敏感性和特异性均为100.0%。32例患者均未发现针道种植及感染。结论:FNA诊断妇科肿瘤的敏感性及特异性高,具有重要的临床价值。     

超声造影结合细针穿刺活检诊断甲状腺结节

目的 探讨超声造影结合细针穿刺活检在诊断甲状腺结节方面的临床价值。 方法 观察我院98例甲状腺结节患者的98个结节,每例患者依次进行二维超声检查及超声造影后,再在超声引导下行细针穿刺活检。以手术病理为标准,评价超声造影及细针穿刺活检对甲状腺结节诊断的准确性。 结果 98例甲状腺结节患者,手术病理诊断良性结节40例,恶性结节58例,超声造影及细针穿刺活检诊断甲状腺结节的敏感性、特异性、准确性分别为72%、68%、70%及78%、73%、76%;超声造影结合细针穿刺活检诊断甲状腺结节的敏感性为91%、特异性为90%、准确性为90%,两种检查方法结合可提高甲状腺结节诊断的敏感性、特异性和准确性,差异有统计学意义（P<0.05）。 结论 超声造影结合细针穿刺活检可在术前更准确、更安全的判断甲状腺结节的良恶性,对甲状腺结节的诊断具有重要的临床意义。       

细针穿刺联合CD147检测对鉴别诊断甲状腺癌的价值

目的研究细针穿刺联合分子标志物CD147检测在甲状腺癌中的应用价值。方法选择2011-2015年收治的48例甲状腺结节患者为研究对象,对患者术后标本进行细针穿刺检测,并对疑似恶性肿瘤的患者进行免疫组化CD147染色分析,若CD147为(+)则判定为恶性,并将其与病理结果相比较。结果 CD147染色结果阴性患者28例,经术后病理检查发现恶性6例,良性22例。良性和恶性结节中,CD147染色结果差异有统计学意义(P0.05)。CD147染色结果与B超提示钙化结节及淋巴结发生转移的关系差异有统计学意义(P0.05)。超声的检测敏感性、阳性预测值及准确率相比单纯细针穿刺和细针穿刺联合分子标志物检测比较,差异有统计学意义(P0.01)。结论分子标志物CD147免疫是诊断甲状腺肿瘤的重要标志物,细针穿刺联合CD147组化分析能明显提高甲状腺癌的术前检出率。     

细针吸取细胞学对甲状腺乳头状癌亚型的诊断价值

目的探讨细针吸取细胞学(FNAC)对甲状腺乳头状癌亚型诊断的准确性。方法取同时有术前FNAC检查和术后病理诊断的甲状腺乳头状癌154例，其中资料完整者140例。分别对其组织学切片和细胞学涂片进行亚型诊断。结果对甲状腺乳头状癌亚型诊断准确率分别为经典型91．6％，滤泡型75％，高细胞型90％，高级别型85．7％。结论经典型、高细胞型和高级别型乳头状癌的亚型诊断准确。滤泡型和嗜酸细胞型乳头状癌容易低诊断为滤泡性肿瘤和嗜酸细胞肿瘤，实体型、弥漫硬化型乳头状癌的亚型诊断有待进一步总结。     

Utility of the Ultrasound Elastographic Systolic Thyroid Stiffness Index in Reducing Fine‐Needle Aspirations

Objective . The purpose of this study was to evaluate whether ultrasound elastography performed by using carotid pulsation as a compression source and generating the systolic thyroid stiffness index (STSI) can be used as a pre–fine‐needle aspiration (FNA) screening tool. Method . Ultrasound data previously acquired from 62 thyroid nodules in 59 patients who underwent a thyroid FNA were used. Pulsation from the carotid artery was used as the compression source, and the strain was calculated offline. A metric called the STSI was computed for each nodule during systole. On the basis of the derived STSI value, thyroid nodules were retrospectively classified into 2 types: I, no FNA (observation only); and II, FNA. Results . The STSI value of malignant nodules (n = 12) was significantly higher than that of benign nodules (n = 39; P < .00002). Using an STSI cutoff value of 10, 31 nodules were classified as type I, all of which were benign, whereas 20 nodules were classified as type II, 12 malignant and 8 benign, with sensitivity of 100% and specificity of 79.4%. This suggests that ultrasound elastography could have screened out 31 type I nodules, reducing the number of FNAs by 60.8%. Conclusion . Thyroid ultrasound elastography has the potential to substantially reduce the number of FNA biopsies by detecting type I benign nodules. Patients with suspicious type II nodules would be referred for an FNA. Future prospective studies are needed to confirm the efficacy of thyroid ultrasound elastography as a triage tool to FNA.     

薄层液基细胞学涂片在超声引导下甲状腺细针抽吸活检的应用

  目的  探讨薄层液基细胞学涂片技术在超声引导下甲状腺穿刺中的应用价值。  方法  2008年1月至7月57例患者的57个甲状腺病变进行超声引导下细针抽吸细胞学检查并同时进行薄层液基细胞学涂片。其中14例获得手术病理, 其余病例全部进行临床随访, 随访时间5年至5年6个月。细胞学及组织学诊断结果分为四类:良性、恶性、可疑恶性及涂片不满意, 将其与手术病理及临床随访结果进行对照分析, 分析薄层液基细胞学涂片的细胞学特征及对甲状腺结节的诊断价值。  结果  薄层液基细胞学涂片与常规细胞学涂片特征有一定差异, 主要表现在背景血细胞明显减少、细胞量较多、集中, 胶质量少或浓集、核较深染、细胞皱缩更常见、常见细胞质碎片及裸核。57个甲状腺病变中, 经手术病理及临床随访证实恶性6个, 良性51个。薄层液基细胞学涂片诊断良性48个(84.2%), 恶性4个(7.0%), 涂片不满意5个(8.8%)。该技术诊断甲状腺恶性结节的敏感性66.7%, 特异性100%, 准确率94.5%, 阳性预测值100%, 阴性预测值96.2%。与常规细胞学涂片诊断结果相似。  结论  薄层液基细胞学涂片细胞学特征与常规涂片有一定差异, 诊断准确性与常规涂片相似, 在甲状腺结节细针抽吸细胞学检查中有较好的应用价值。     

Mediastinal ectopic thyroid diagnosed by endobronchial ultrasound‐guided transbronchial needle aspiration: Report of three cases

An ectopic thyroid gland results from the abnormal migration of the thyroid in the course of its development. Primary ectopic mediastinal thyroid is very rare and occurs in less than 1% of all goiters that can be surgically excised. Ectopic thyroid tissue has a characteristic sonographic appearance as smooth‐bordered, homogeneous, hypoechoic tissue with fine specular echoes. We report 3 cases of mediastinal ectopic thyroid diagnosed by endobronchial ultrasound‐guided transbrochial needle aspiration biopsy.     

Sonographically guided core biopsy in the assessment of thyroid nodules

PURPOSE: This study was conducted to assess the value of sonographically guided core biopsy in the evaluation of thyroid nodules by comparison with fine-needle aspiration cytology (FNAC) performed with and without sonographic guidance. METHODS: We performed a retrospective analysis of a consecutive series of 645 thyroid samples obtained at a single center. Samples came from 422 patients who underwent FNAC (with or without sonographic guidance), sonographically guided core biopsy, or excision of thyroid tissue with or without prior frozen sectioning. Final diagnoses were obtained from surgery or clinical follow-up. Initial and final diagnoses were compared. RESULTS: Adequate samples for assessment were obtained in 87% of core biopsies, compared with 60% of cytology aspirates (p <0.001). Sonographically guided core biopsy and sonographically guided FNAC both had zero false-negative rates for the diagnosis of malignancy, compared with a 7.0% false-negative rate (95% confidence interval, 2.0-12.0%) for aspiration cytology when sonography was not used. With core biopsy, 11% of patients required surgical confirmation of the diagnosis, compared with 43% of patients following FNAC (p <0.001). There were no major complications following core biopsy. CONCLUSIONS: Sonographically guided core biopsy provides an accurate and safe alternative to FNAC in the assessment of thyroid nodules.     

Prevalence of malignancy in thyroid nodules with an initial nondiagnostic result after ultrasound guided fine needle aspiration

The objective of this study was to determine the rate of malignancy in thyroid nodules with an initial nondiagnostic fine needle aspiration. From October 2001 to April 2007, biopsies were performed on 1344 thyroid nodules in our practice. Biopsies were performed on nodules using 25-27 gauge needles, ultrasound guidance and multiple passes using both suction and capillary action. We retrospectively reviewed the results of these biopsies as well as any further management of nodules that received nondiagnostic results (IRB HUM00006459). Following initial biopsy, 295/1344 (21.9%) of nodules received nondiagnostic pathologic results. Of this population, 39 nodules (13.1%) were lost to follow-up. Of the remaining 256 nodules that received a repeat FNA, surgical excision, or greater than 24 months of clinical and imaging follow-up, only five cancers were detected, representing only 2% of the population that received an initial nondiagnostic biopsy result. All of these cancers were papillary neoplasms. When rigorous, ultrasound-guided, fine needle aspiration of thyroid nodules is performed, a nondiagnostic histopathologic result should not be interpreted as suspicious for thyroid cancer. Given the low rate of malignancy in this population (2%), we suggest that clinical and imaging follow-up of these nodules, opposed to repeat sampling, is warranted.     

针吸穿刺细胞病理学在甲状腺疾病检验中的应用体会

目的将传统细针穿刺法与“友谊式细针穿刺器”穿刺法在诊断甲状腺肿块中的价值进行比较,以期为临床诊断甲状腺疾病提供有力的诊断依据。方法使用徒手操作注射器负压针吸标本采集法及友谊式细针穿刺器负压针吸标本采集法,并且使用瑞氏染色法与H—E染色法进行涂片染色。就组织结构和细胞形态进行比较。结果243例甲状腺病例中,其中乔本甲状腺炎127例,占甲状腺疾病的52．3％;甲状腺良性肿瘤45例,占甲状腺疾病的18．5％;甲状腺癌6例,占甲状腺疾病2．5％;亚甲炎15例,占甲状腺疾病的6．2％;结节性甲状腺肿为27例,占甲状腺疾病的11．1％;许特莱细胞瘤1例。其中注射器负压针吸标本采集法采集标本141例,友谊式细针穿刺器负压针吸标本采集法采集标本102例。在甲状腺腺瘤、结节性甲状腺肿和甲状腺囊性变病例,友谊式细针穿刺器负压针吸标本采集法准确率分别为98．8％、91．7％和92．3％。在桥本甲状腺炎、亚甲炎病例,徒手操作注射器负压针吸标本采集法准确率分别为92．6％、90．9％。在甲状腺癌病例,两种方法准确率相同。结论,临床上在根据触感及其它辅助诊断考虑有甲状腺炎性改变倾向时,建议使用徒手操作注射器负压针吸标本采集法;而当考虑有肿瘤性改变时,推荐使用友谊式细针穿刺器负压针吸标本采集法。