超声造影结合粗针活检诊断甲状腺结节的临床应用价值

【摘要】 目的 探讨超声造影结合粗针活检诊断甲状腺结节的临床应用价值。方法 回顾超声造影结合超声引导下粗针活检(core-needle biopsy, CNB)诊断甲状腺结节81例患者共89个结节的超声检查资料和粗针活检病理资料,最后与手术病理结果对照分析。结果 超声造影诊断甲状腺良恶性结节的敏感性为86.7%、特异性为95.8%、准确性为91.0%。超声引导下粗针活检取材成功率100%,与手术病理结果符合率98.9%。结论 超声造影技术诊断甲状腺结节具有较高的临床价值,结合应用超声引导下粗针穿刺活检可全面准确、安全、简便的诊断甲状腺疾病,值得在临床加以推广应用。     

超声介入微创组织病理活检在甲状腺结节诊断中的临床意义

目的：探讨超声介入微创组织病理活检技术在甲状腺结节诊断中的临床意义。 方法：回顾性分析2008年10月—2010年4月在彩色多普勒超声引导下用美国巴德穿刺活检系统完成甲状腺结节患者微创组织病理活检528例（共591个结节）临床资料, 结节直径0.4～1.5 cm, 平均0.76 cm。 结果：528例患者活检取材, 穿刺成功率为99.4%（525/528）。活检诊断为甲状腺癌的161例, 良性病变367例。活检后行手术治疗226例, 病理符合率98.7%。假阴性（甲状腺癌误诊为良性疾病）3例, 假阴性率1.3%（3/226）, 无假阳性。同时行颈部肿大淋巴结病理活检27例, 活检病理与术后石蜡病理结果一致。活检后患者均未出现明显不适, 发生腺体表面及肌间血肿22例, 无特殊处置平均1个月后自行缓解。 结论：超声介入微创组织活检技术对甲状腺结节和转移性颈淋巴结诊断的临床符合率高, 特别是对于微小结节的术前诊断具有较高的价值, 既可避免不必要的过度治疗, 又可减少甲状腺癌的漏诊。     

甲状腺癌的诊断治疗

目的探讨甲状腺癌诊断及治疗方法。方法回顾性分析我院2002—2008年行手术治疗的甲状腺癌患者236例的临床资料。结果本组患者术前B超检查发现甲状腺内实性或囊实性结节2 2 5例(9 5.5 3%),结节内伴微钙化灶者7 8例(3 3.0 5%);B超引导下细针穿刺活检8 1例,阳性率8 7.6 5%;术中冰冻切片检查2 2 1例,诊断甲状腺癌2 0 8例,阳性率9 4.1 1%;术后病理检查证实有淋巴结转移者为6 8例(2 8.8 1%)。行甲状腺部分切除1 5例,患侧叶全切4 4例,根治性切除1 7 7例。因误诊行甲状腺癌局部或患侧叶切除术后确诊行二次以上手术者2 5例,残癌率为5 6.0%(1 4/2 5)。结论 B超检查提示甲状腺结节内微钙化灶对甲状腺癌诊断有重要提示意义,结合B超引导下细针穿刺活检可明显提高术前诊断准确率,术中冰冻切片检查是确诊甲状腺癌的重要方法。患叶全切+峡部全切+对侧大部切除+选择性颈清扫术是甲状腺癌的主要手术方式。对术中误诊术后确诊者应及早行二次手术。     

甲状腺结节超声引导下粗针穿刺组织学活检的有效性研究

目的研究甲状腺结节超声引导下粗针穿刺(US－CNB)组织学活检的有效性,探讨其对甲状腺结节的诊断价值。 方法回顾性分析2009年6月至2016年6月行术前US－CNB的2 051例患者的2 286个结节的病理诊断,将其中在本院行手术切除的530个甲状腺结节纳入本研究。以术后组织病理学为金标准,采用SPSS 19.0统计软件分析处理数据,分析US－CNB病理诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度,并用ROC曲线对比粗针穿刺活检病理结果及手术病理结果。 结果US－CNB的2 286个甲状腺结节中仅2例取材不成功,2 284个(99.9%)结节取材切片成功,得到组织病理诊断;530个术后结节的US－CNB的诊断敏感度、特异度、阳性预测值、阴性预测值、准确度分别99.8%、86.5%、98.6%、97.8%和98.5%。 结论由于US－CNB对甲状腺结节有很高的取材成功率及病理诊断准确率,从而对甲状腺结节有很高的术前诊断价值。     

超声引导下细针穿刺抽吸活检对甲状腺床病灶的应用价值

目的探讨超声引导下细针穿刺抽吸活检(US-FNAB)对甲状腺癌术后甲状腺床新生病灶的临床应用价值。方法回顾性分析于我院接受US-FNAB的63例次甲状腺癌患者术后新生甲状腺床病灶,分别评估病灶大小及超声引导下细针穿刺细胞学结果,并与手术病理结果及临床随访结果进行对照分析。结果 63例次患者的69个病灶中,细胞学结果满意60个,诊断为恶性38个,可疑恶性4个,良性18个;细胞学结果不满意9个。与最终临床诊断结果对照,USFNAB诊断甲状腺床病灶的敏感度为97.62%(41/42)、特异度为94.44%(17/18)、阳性预测值为97.62%(41/42)、阴性预测值为94.44%(17/18)、准确率为96.67%(58/60)。结论 US-FNAB对甲状腺癌术后甲状腺床新生病灶具有较高的诊断价值。     

甲状腺结节大小对超声引导下细针穿刺活检诊断效能的关联性分析

目的分析甲状腺结节大小对超声引导下细针穿刺活检诊断效能的关联性。方法选取本院于2017年1月至2019年12月行超声引导下细针穿刺活检以诊断甲状腺结节的患者62例的临床资料,对以上患者进行回顾性分析。根据甲状腺结节的大小分为三个组,A组≤10mm,B组10～20mm,C组≥20mm。总结患者施行超声引导下甲状腺结节细针穿刺诊断,以手术病理为金标准,比较超声引导下细针穿刺活检检查各组甲状腺结节的敏感性、特异性、阳性预测值、阴性预测值和准确率。结果对78个穿刺所得的结节进行分类,A、B、C组无诊断意义率分别为5/34(14.7%)、3/21(14.3%)、3/23(13.4%),各组间差异比较不具备统计学意义,P0.05。A、B、C组间的敏感度、特异性、阳性预测值、阴性预测值和准确率比较差异不显著,不具备统计学意义(P0.05)。结论对甲状腺结节患者予以超声引导,各结节的大小对超声引导下细针穿刺活检诊断效能未见明显的影响。     

超声引导下甲状腺细针穿刺检查在甲状腺肿瘤诊断中的应用价值

目的研究甲状腺肿瘤患者行超声引导下甲状腺细针穿刺检查的诊断价值。方法选取2013年1月至2015年12月本院接诊的1450例甲状腺结节的患者进行研究。所有患者均进行超声引导下甲状腺细针穿刺检查,与术后病理结果进行对照分析,并分析患者病变部位情况。结果术后病理确诊分析发现,超声引导下细针穿刺对分化型甲状腺癌、未分化癌的诊断符合率分别为95.09%、76.92%,对于甲状腺良性肿瘤的诊断符合率高达96.96%。超声引导下细针穿刺检查对分化型甲状腺癌的敏感性和特异性分别为94.65%和95.24%,对于甲状腺未分化癌的敏感性和特异性分别为75.0%和99.93%,对于甲状腺良性肿瘤,诊断的敏感性也为97.99%,诊断效果较好。双侧甲状腺肿瘤发病率高达44.76%,右侧甲状腺发病率为25.17%,左侧发病率为25.03%,甲状腺峡部发病率为5.03%。结论超声引导下甲状腺细针穿刺检查在甲状腺肿瘤诊断中的应用价值较高,诊断敏感性、特异性及符合率均较高,且对患者发病的病变部位诊断效果明确,值得广泛推广应用。     

超声引导下微创组织活检技术在甲状腺外科的应用

目的 探讨超声引导下微创组织活检技术在甲状腺疾病诊治中的指导意义.方法 总结吉林大学中日联谊医院甲状腺外科2008年10月至2009年7月间,117例(共131个结节,结节直径大小在0.5～1.5 cm之间,平均直径约0.8 cm)甲状腺疾病患者,行超声引导微创组织活检的临床资料并进行分析.结果 117例患者,活检取材满意,行组织活检后均未出现明显不适及活检后并发症.其中59例患者活检后行手术治疗,仅有2例术前活检病理与术后石蜡病理未完全符合;未行手术治疗的58例患者,结合症状、查体、甲状腺功能和彩色多普勒超声等辅助检查,行对症治疗并定期复查,症状及彩色多普勒超声下影像均有明显好转,治疗效果良好.117例微创组织活检患者中8例同时行颈部肿大淋巴结活检,活检病理与术后石蜡病理结果一致(7例为转移癌,1例为反应性增生),准确率为100%.结论 超声引导下微创组织活检术对甲状腺疾病的诊治有重要的指导意义,临床符合率高,特别是对于微小结节的术前诊断具有较高的价值,既可避免不必要的过度治疗,又可减少甲状腺癌的漏诊,同时本技术具有简便易行、安全准确的优点,在甲状腺外科具有一定的临床应用价值.     

超声引导下粗针穿刺活检鉴别诊断甲状腺结节良恶性

目的探讨超声引导下粗针穿刺活检(US-CNB)诊断甲状腺结节良恶性的价值。方法回顾性分析146例接受US-CNB的甲状腺疾病患者(152个结节)的病理资料,以术后病理结果为金标准,计算US-CNB病理诊断甲状腺恶性肿瘤的准确率。结果 US-CNB病理诊断甲状腺恶性肿瘤的敏感度、特异度、准确率分别为97.82%(90/92)、96.43%(54/56)和97.30%(144/148);对直径≥0.7cm结节的诊断准确率[0.7~1.0cm:95.65%(22/23),1.1~1.5cm:100%(38/38),1.6~2.0cm:100%(50/50),2.0cm:100%(29/29)]高于直径0.7cm结节[62.50%(5/8),P均0.05]。结论 US-CNB鉴别诊断甲状腺良恶性结节操作简单、定位准确、创伤小、并发症少、准确率高,可作为非手术条件下获取病理组织的首选方法。     

甲状腺癌的术前诊断及临床意义

目的 探讨超声及超声引导下细针穿刺细胞学检查对甲状腺癌的术前诊断及其临床意义。方法 将32例经手术证实的甲状腺癌患者的超声影像学超声引导下的细针穿刺细胞学检查结果进行分析，并与病理对照。结果 超声诊断甲状腺癌41例，术后病理确诊32例，诊断符合率为78．0％；超声引导下细针穿刺细胞学检查，35例细胞学诊断为甲状腺癌，与术后病理诊断符合率为91．4％。结论 术前采用高频超声及超声引导下的细穿刺细胞学，可提高甲状腺癌的术前诊断率，为制定根治性手术方案提供依据。     

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??Value of core needle biopsy in the diagnosis of breast neoplasms??A report of 1394 cases ZHANG Guo-fen*, ZHANG Hong, XIN Ling, et al. *Department of General Surgery, the First Hospital of Tsinghua University, Beijing 100016, China
Corresponding author: LIU Yin-hua, E-mail: liuyinhua@medmail.com.cn
Abstract Objective To investigate the accuracy and consistency in pathological neoplasms of breast lesions diagnosed by ultrasound-guided core needle biopsy ??CNB??and postoperative pathological examination. Methods The clinicopatholagical data of 1394 consecutive cases of breast lesions examined by ultrasound-guided CNB performed between January 2009 and October 2013 in the First Hospital of Peking University were analyzed retrospectively. The agreement of pathological diagnosis between the CNB and subsequent excision pathology was analyzed to evaluate to value of CNB. Results There were 1046 cases of breast cancer in the final diagnosis after surgical excision among 1394 breast lesions and 1037 of them were diagnosed by CNB. Nine cases of false negative breast cancer were diagnosed by CNB. The sensitivity (true positive) of CNB was 99.1%, specificity (true negative) was 100%, Youden’s index was 0.991, and positive predictive value and negative predictive value were 100% and 97.5% respectively. The Kappa value was 0.983??P??0.01??. Conclusion Ultrasound-guided CNB with histopathological assessment is accurate in diagnosis of breast neoplasms and has a great consistency with postoperative pathological examination. It is an accurate, safe and reliable method for the diagnosis of breast lesions with less-injury.     

超声引导下细针穿刺在甲状腺小结节诊断中的应用

目的探讨超声引导下细针穿刺（fineneedleaspiration,FNA）在甲状腺小结节诊断中的价值。方法2013年1月-2014年1月对38例毗邻周围重要脏器的39枚甲状腺小结节（直径0．6～1．2cm,平均0．8cm）超声引导下行FNA检查,以手术病理为标准,判定超声引导下细针穿刺的准确性,同时评估本方法的安全性。结果均未发生出血、毗邻脏器及神经损伤等并发症。手术病理证实甲状腺癌33枚,包括术前FNA诊断恶性结节28枚,无法判断病理类型2枚,取材过少无法诊断3枚;良性结节6枚,包括FNA诊断良性结节2枚,无法判断病理类型1枚,取材过少无法诊断3枚。FNA取材过少无法进行病理诊断6枚,取材不足率15．4％（6／39）。FNA诊断敏感性、准确性分别为93．3％（28／30）和93．9％（30／33）;与手术病理的一致性Kappa=0．718,McNemarz。检验,P=0．500。结论超声引导下FNA活检甲状腺小结节是一种安全准确的检查方法。     

Solitary thyroid nodule: current management

Clinically, solitary thyroid nodules are common, being present in up to 50% of the elderly population. The majority are benign with thyroid cancer representing an uncommon clinical problem. Investigation should include careful history and examination and thyroid function tests. Toxic or autonomous nodules are rarely malignant and require radionuclide scan for assessment. If euthyroid, then fine needle biopsy provides direct specific information about the cytology of the nodule from which the histology can be inferred. Thyroid 'incidentalomas' are a common management problem. Non-palpable nodules greater than 1.0 to 1.5 cm represent an absolute indication to perform an ultrasound-guided fine needle biopsy. An atypical fine needle biopsy mandates formal diagnostic excision. Because it is not possible to distinguish a follicular carcinoma from a follicular adenoma on cytological grounds alone, this category must simply be interpreted as indicating a follicular tumour and up to 20% will be malignant. Hemithyroidectomy via a 'collar' incision, with submission of the specimen to formal pathological examination, remains the standard of care, with completion total thyroidectomy for cancers other than low risk papillary cancer and 'minimally invasive' follicular cancer without vascular invasion. The issue of whether follicular adenomas can potentially develop into follicular carcinomas has yet to be satisfactorily resolved. The major challenge in the management of the solitary thyroid nodule remains the assessment as to which nodules require surgical excision and which can be followed conservatively.     

超声影像引导的乳腺病灶经皮穿刺组织病理学检查的临床应用

目的评价超声影像引导的乳腺病变经皮空芯针穿刺（CNB）组织病理检查方法的准确性及其影响因素。方法回顾性分析2000年1月至2006年5月收治的2152例乳腺病变患者经皮CNB组织病理检查结果及临床资料。比较穿刺与切除组织病理诊断之间的一致性,并对未进行切除活检的患者进行随访。结果在最终诊断为乳腺癌的1461例患者中,CNB病理结果显示,乳腺癌1339例,假阴性率为3．5％（51／1461）,低估率为4．9％（71／1461）。50．0％（17／34）的导管上皮非典型增生和46．3％（25／54）的乳头状病变在重新活检中诊断为癌。B超引导CNB的假阴性率（2．1％,22／1068）显著低于徒手引导CNB（7．4％,29／393）（P〈0、05）。两名专责医师CNB的假阴性率（1．2％,8／681）显著低于非专责医师（5．5％,43／780）（P〈0、05）。738例经CNB诊断良性病变中,417例进行手术切除活检,50例诊断为乳腺癌,205例良性病变随访2—29个月（中位随访时间10、2个月）,发现1例恶性病变。结论超声影像引导的乳腺病灶经皮病灶穿刺组织病理检查是准确可靠的诊断方法。对于穿刺病理结果为高危病变者应予切除活检。     

Prediction of malignancy in the solitary thyroid nodule by physical examination, thyroid scan, fine-needle biopsy and serum thyroglobulin. A prospective study of 100 surgically treated patients

A prospective study was made of 100 consecutive patients selected for surgical treatment of a clinically solitary thyroid nodule. Anamnestic data and findings at physical examination, thyroid scan, fine-needle aspiration biopsy and measurement of serum thyroglobulin were correlated with the postoperative histologic diagnoses. The histologic findings were malignant in 18 cases and benign in 82. Familial occurrence of benign goiter was reported more frequently by patients with benign than by those with malignant histology (46 and 11%). Of the 11 nodules that were hard at palpation, 7 were malignant. All 12 scintigraphically "hot" nodules were benign, but 13 of 59 "solitary, cold" nodules were malignant. The cytologic specimens were reviewed and reclassified. The needle aspirate was insufficient for cytologic diagnosis in 11 cases. Papillary carcinoma was cytologically recognized in four cases. Of 36 lesions cytologically reported to be neoplasm of unspecified type, 12 were histologically shown to be malignant, 20 were follicular adenomas and 4 were colloid goiter. Benign lesion was the cytologic diagnosis in 47 cases. One diagnosis was false negative, but the cancer lay beneath the index nodule. The thyroglobulin level was significantly higher in patients with thyroid cancer than in those with benign disorders, but the test's predictive value was low. Thyroglobulin levels more than tenfold the upper limit of normal were found only in three patients with thyroid cancer and two with thyrotoxicosis. Although all of the mentioned investigative data were helpful in the management of solitary thyroid nodule, fine-needle biopsy was the best single method. When cytologic examination shows malignancy or unspecified neoplasm, surgery is indicated. For most patients with cytologically benign lesions, careful follow-up will suffice.     

基于FNAB的分子检测技术在甲状腺结节诊断中的研究进展

随着各种检测技术的相继问世,甲状腺结节的检出率明显上升。尽管大多数甲状腺结节是良性的,但良恶性病变之间的判定仍然是临床医生面临的挑战。对于所有可疑甲状腺结节患者均应进行颈部超声检查。甲状腺超声可评估结节特征,某些甲状腺结节具有可疑恶性超声征象。然而,这些特征缺乏准确性,无法明确诊断结节的良恶性。目前的指南仍然推荐超声引导细针穿刺活检（FNAB）作为评估甲状腺结节良恶性的首选检查。FNAB是一种经济高效的诊断方法,由于其创伤小,敏感性和特异性较高,可用于术前评估甲状腺结节的性质,已成为临床不可或缺的检查手段之一。近年来国内关于FNAB的报道日益增多,国内外指南关于FNAB指征尚有争议,同时由于其自身存在一定的局限性,FNAB技术的全面实施需要严格把握指征及准确判读穿刺病理结果。FNAB虽然是术前评估甲状腺结节最常用的诊断技术,但仍有灰区结节需要进一步诊断研究。为了制定合理的手术方案及判断预后,指南推荐术前可测定促甲状腺激素（TSH）水平。FNAB作为一个简单且相对无创的技术,但也可产生相应的并发症,FNAB的并发症主要与甲状腺结节的位置、穿刺针的直径、穿刺医师的操作经验等因素相关,严重程度较轻,多呈自限性。对于FNAB无法诊断或意义不明确的非典型病变或滤泡性病变,学者们一直在努力寻找一种新的方法来精确地诊断甲状腺癌。分子生物学方法是目前的最佳选择。分子生物学方法通过检测特定甲状腺肿瘤易感基因的驱动突变来确认甲状腺肿瘤活检的恶性程度,如BRAF和RAS癌基因突变、RET/PTC重排和TERT突变检测,从而提高术前诊断效率。甲状腺乳头状癌最常见的转移部位是局部淋巴结,虽然FNAB对异常淋巴结有诊断价值,但小或囊性淋巴结可能由于缺乏肿瘤细胞而无法诊断。检测可疑颈部淋巴结细针穿刺活检冲洗液中甲状腺球蛋白含量可作为细胞学诊断的辅助手段。笔者认为FNAB联合分子生物学的多层次诊断体系可提高术前诊断的精准性,对指导治疗、判断预后具有重要价值。     

The accuracy of ultrasound, stereotactic, and clinical core biopsies in the diagnosis of breast cancer, with an analysis of false-negative cases

OBJECTIVE: Preoperative core biopsy in breast cancer is becoming the standard of care. The aim of this study was to analyze the various methods of core biopsy with respect to diagnostic accuracy and to examine the management and outcome of those patients with false-negative biopsies. METHODS: All patients undergoing core biopsy for breast abnormalities over a 5-year period (1999-2003) were reviewed. The accuracy rates for each method of core biopsy, the histologic agreement between the core pathology and subsequent excision pathology, and the length of follow-up for cases of benign disease were studied. Patients whose biopsies were benign but who were subsequently diagnosed with cancer underwent detailed review. RESULTS: There were 2427 core biopsies performed over the 5-year period, resulting in a final diagnosis of cancer in 1384 patients, benign disease in 954 patients, and atypical disease in 89 patients. Biopsy type consisted of 1279 ultrasound-guided cores, 739 clinically guided cores, and 409 stereotactic-guided cores. The overall false-negative rate was 6.1%, with specific rates for ultrasound-, clinical-, and stereotactic-guided cores of 1.7%, 13%, and 8.9%, respectively. False-negative biopsies occurred in 85 patients, and in 8 of these patients the diagnosis was delayed by greater than 2 months. In all other false-negative cases, "triple assessment" review allowed prompt recognition of discordant biopsy results and further evaluation. CONCLUSION: Ultrasound guidance should be used to perform core biopsies in evaluating all breast abnormalities visible on ultrasound. Adherence to principles of triple assessment following biopsy allows for early recognition of the majority of false-negative cases.     

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??Clinical application of ultrasound-guided core needle biopsy for breast lesions LI Jin-ping*, LI Juan , WU Li-gang,et al.*Chongqing Medical University, Chongqing 400016, China
Corresponding author ??LIU Qi-lun, E-mail??liuql6311@hotmail.com
Abstract Objective To evaluate the clinical value of ultrasound-guided core needle biopsy (US-CNB) as a preoperative diagnostic modality for breast lesions. Methods Data were collected prospectively from August 2007 to May 2009 for 115 ultrasound-guided core needle biopsy that were followed by excisional breast procedure (EP) within 1 week at our hospital. The histopathological diagnosis on ultrasound-guided core needle biopsy was then compared with the findings of the excisional biopsy. Results Out of the total 115 cases, US-CNB showed 81 as invasive ductal carcinoma, three invasive lobular carcinoma, two ductal carcinoma in situ??two atypical ductal hyperplasia and 26 benign disease. The principle histology identified at CNB was confirmed at EP for 93.9% of the lesions, generating a kappa value of 0.891(P??0.01). The sensitivity for malignancy with CNB was 95.6% and the specificity was 100%. The false negative rate was 4.39% and the false positive rate was 0. Overall, our results indicate moderate agreement between the principal histology identified at USB relative to that identified at EP. Conclusions Ultrasound-guided core breast biopsy is a satisfactory procedure for the histopathological diagnosis of breast lesions. Any unsatisfactory, suspicious or atypical change on US-CNB should be followed by an open biopsy.     

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??Application of ultrasound-guided fine-needle capillary cytology in diagnose of thyroid nodules??A report of 350 cases ZHOU Le,ZHANG Guang, HAN Jing,et al. Department of Thyroid Surgery, China-Japan Union Hospital, Jilin University??Changchun 130033,China
Corresponding author:SUN Hui, E-mail:sunhui1229@163.com
Abstract Ojective To investigate the technique and method to improve the successful rate of thyroid nodule puncture biopsy. Method We used ultrasound-guided fine-needle capillary cytology with multi-faceted pulling approach for thyroid nodule biopsy. The result was compared with post-operative paraffin pathological findings. Result A total of 350 cases(394 thyroid nodules) with biopsy results were involved, in which specimen of 35 nodules (9%) can not be diagnosed or dissatisfied; in the rest,138 nodules of benign, 56 nodules of undetermined atypical cells lesions or follicular lesions, none of follicular or suspicious follicular neoplasm, 30 nodules of suspicious malignancy, and 135 nodules of malignancy(34%, 133 nodules of papillary carcinoma, 2 nodules of medullary carcinoma). Compared with post-operative histopathology findings of 159 nodules, the sensitivity and the specificity were 88% and 79%. After the first 50 cases were excluded for the effect of the learning curve, the sensitivity and the specificity reached to 93% and 76%. 7 cases occurred local tiny hematoma during operation .No serious complication occurred. Conclusion The reformed ultrasound-guided fine-needle capillary cytology meets the requirements of drawing matieral and simply operating ; after a period of learning curve, the technology would help to significantly improve the diagnostic sensitivity of thyroid nodules.