二维超声在甲状腺细针穿刺中的应用

目的 通过对甲状腺恶性结节超声特征的筛选,探讨超声引导下细针穿刺细胞学检查对甲状腺结节术前评估的意义.方法 回顾2010年12月-2011年8月首都医科大学附属北京同仁医院耳鼻咽喉-头颈外科进行超声检查、超声引导下细针穿刺细胞学检查并行手术治疗的39例甲状腺结节患者.将超声特征、细针穿刺细胞学结果与术后病理进行对照分析,筛选恶性结节的超声特征.结果 超声引导下甲状腺结节细针穿刺细胞学的灵敏度为80.0％,特异度为89.4％,误诊率为11.0％,漏诊率为20.0％.甲状腺结节实性、纵横比≥1、钙化直径＜2mm、形态不规则、边界欠清、Ⅲ型血流等超声特征在恶性结节和良性结节中差异有统计学意义(P＜0.05).其中纵横比及形态的特异度较高,分别为90.5％及85.7％.但没有一个单独的超声特征集高灵敏度、高阳性预测值为一体可作为评估甲状腺恶性结节的指标.结论 具备任意两项特异性超声特征的结节可作为高危恶性结节进行细针穿刺,可减少实施穿刺的例数.     

细针穿刺细胞学检查对乳腺癌的诊断意义

目的 探讨细针穿刺细胞学检查对乳腺癌的诊断意义。方法 用带7号针头的一次性塑料5～10ml注射器，对439例病人的乳腺和腋下肿物进行细针穿刺细胞学检查，并与术后诊断作比较，观察其准确率。结果 本组病例作细针穿刺细胞学检查的准确率达97．2％。结论 细针穿刺细胞学检查安全、方便、准确率高，可作为乳腺癌的一种常规检查手段。     

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目的 探讨乳腺肿块细针穿刺端粒酶活性检测在乳腺癌术前诊断中的临床应用价值。方法 对８５例乳腺肿块病人者细针穿刺,对穿刺细胞分别用端粒重复扩增法（ＴＲＡＰ）进行端粒酶活履检测和光镜细胞检查。以术后石蜡病理切片结果最地两种检测方法在术前诊断乳腺癌方面的灵敏度、特异性和约登指数进行了比较。结果 术前端粒酶活性检测同穿刺细胞学相比,特异性分别为７３．９％和８２．６％（Ｐ〉０．０５）,差异无显著性;灵敏度分     

超声引导下甲状腺结节细针穿刺抽吸活检术后出血原因分析

目的:探讨超声引导下甲状腺结节细针穿刺抽吸活检(US-FNAB)术后局部出血发生的原因。方法:对2012年9月至2014年9月行甲状腺单发结节US-FNAB的708例病人进行回顾性分析,根据术后有无出血分为两组,评估术后发生出血与甲状腺结节特征及穿刺时操作情况的相关性。结果:甲状腺结节US-FNAB后出血发生率为8.6%(61/708)。结果表明结节部位、病灶与包膜接触、甲状腺实质血流增多及操作者经验与术后出血相关(P<0.05)。结论:甲状腺结节US-FNAB是一种安全的活检方法,控制相关危险因素将有效降低US-FNAB术后出血的发生。     

我国甲状腺结节细针穿刺活检技术应用现状及进展

细针穿刺活检（FNAB）作为甲状腺结节诊断的新技术,以其高敏感度和高特异度被国内外医疗工作者广泛认可。我国FNAB技术起步相对较晚,各地技术掌握水平参差不齐。纵观近10年甲状腺结节FNAB临床报道发现,我国FNAB发展具有迅猛发展、热点层出的特征,然而,在临床指征把握、穿刺取材以及结果判读上仍存在良莠不齐、有待规范等问题。因此,严格把握穿刺指征、获取满意穿刺标本和准确判读穿刺结果有助于FNAB质量控制措施的全面施行,推进甲状腺疾病迈向精准医疗时代。     

内镜超声引导下胰腺占位性病变细针穿刺活检的评价

目的采用内镜超声引导下细针穿刺活检对胰腺肿块进行定性诊断，为手术方式及其它治疗方法的选择提供依据，并评价该法的临床意义。方法对CT、MRI和B超诊断为胰腺占位性病变的16例病人进行了内镜超声引导下穿刺活检（EUS-FNAB），同时观察病变的大小、形态、位置、有无周围血管侵犯和淋巴结转移。结果16例中12例（75％）得到足够的细胞量，8例（50％）得到足够的组织量。其中11例（68．6％）经病理和（或）细胞学诊断为胰腺癌或高度疑似胰腺癌，3例仅见炎性上皮细胞，8例病人经手术证实。EUSFNAB诊断的敏感性为78．6％，特异性为100％，病人均未出现感染、出血、胰瘘和胰腺炎等并发症。结论内镜超声引导下对胰腺占位性病变的细针穿刺活检在鉴别诊断中具有重要的价值，值得临床推广应用。     

超声引导下细针穿刺抽吸甲状腺结节标本质量的影响因素

目的 观察超声引导下细针穿刺抽吸（US-FNA）甲状腺结节标本质量的影响因素。方法 选取388例接受US-FNA的甲状腺结节患者（共436个结节）,根据标本背景的血液成分、细胞数目、存留组织框架及细胞破坏程度将其分为诊断优越组（n=325）和非诊断优越组（n=111）,比较其超声特征,主要包括结节最大径、形态、边界、回声、钙化及血供,分析影响US-FNA标本质量的因素。结果 组间甲状腺结节最大径、内部钙化及Adler血供差异均有统计学意义（P均<0.05）。甲状腺结节最大径及钙化为US-FNA标本质量的影响因素（P=0.010、0.002）。结论 超声所见甲状腺结节最大径及钙化为其US-FNA标本质量的影响因素。     

Frozen section and fine needle aspiration biopsy in thyroid surgery — needles and sections

Purpose  

To review our own experience with fine needle aspiration biopsy (FNAB) and frozen section (FS) in thyroid surgery and to assess the value of FNAB and FS in predicting malignancy in patient with thyroid disease.     

A sensitivity and specificity comparison of fine needle aspiration cytology and core needle biopsy in evaluation of suspicious breast lesions: A systematic review and meta-analysis

PurposeBreast cancer detections for women with suspicious lesions mainly depend on two non-operative pathological tests-fine needle aspiration cytology (FNAC) and core needle biopsy (CNB). The aim of this systematic review was to compare the sensitivity and specificity of CNB and FNAC in this setting.MethodsThe data sources included MEDLINE, EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials (CENTRAL) till February 2016. We included prospective series of studies which directly compared the accuracy of FNAC and CNB. We used forest plots to display the sensitivity and specificity of FNAC and CNB respectively. Pre-specified subgroup analyses and sensitivity analysis were conducted.ResultsUltimately, 12 articles (1802 patients) were included in the final analysis. The pooled analysis shows that the sensitivity of CNB is better than that of FNAC [87% (95% CI, 84%–88%, I² = 88.5%) versus 74% (95% CI, 72%–77%, I² = 88.3%)] and the specificity of CNB is similar to that of FNAC [98% (95% CI, 96%–99%, I² = 76.2%) versus 96% (95% CI, 94%–98%, I² = 39.0%)]. For subgroup analysis, the sensitivities of both tests are better for palpable lesions than that of non-palpable lesions. Sensitivity analysis shows the robustness of the primary analysis.ConclusionOur study suggests that both of FNAC and CNB have good clinical performance. In similar circumstances, the sensitivity of CNB is better than that of FNAC, while their specificities are similar. FNAC could be still considered the first choice to evaluate suspicious nonpalpable breast lesions.     

The diagnostic value of fine needle aspiration in parotid lumps

Introduction

Fine needle aspiration (FNA) is a safe and quick method of diagnosing superficial lumps, which aids preoperative planning. However, FNA of the parotid gland has not gained the widespread acceptance noted in other head and neck lumps. The aim of this study was to determine the ability of FNA of the parotid gland to differentiate benign and malignant disease, and to determine the impact on surgical outcome.

Methods

A retrospective analysis of 201 consecutive parotid operations with preoperative FNA in a large district hospital in the UK was performed. The diagnostic characteristics were calculated for benign and malignant disease, and the impact on surgical procedure was determined.

Results

In identifying benign disease, FNA has a sensitivity of 85% and a specificity of 76%. In detecting malignant disease, FNA has a sensitivity and specificity of 52% and 92% respectively. A false positive on FNA was associated with a higher incidence of neck dissection.

Conclusions

FNA is a useful diagnostic test. However, owing to low sensitivity, it is necessary to interpret it in the context of all other clinical information.     

The role of fine-needle aspiration cytology in the surgical management of thyroid cancer

Background: Diagnosis of thyroid malignancy relies on clinical assessment, imaging and fine‐needle aspiration cytology ‘FNAC’ of thyroid nodules. The purpose of this study was to evaluate how effective synoptically reported FNAC is in clinical practice in diagnosing thyroid cancer. We also examined the effectiveness of using preoperative FNAC results to plan the type of operation for treating thyroid cancer. Method: A retrospective case series of all patients undergoing thyroid surgery from 1993 to 2008 was analysed. All data were collected prospectively and recorded in a dedicated endocrine surgery database. Data analysed included age, sex, preoperative FNAC result, type of surgery, final histology and complications. Cytology was reported based on a five‐tiered classification system. Results: There were 1373 patients in total and 125 patients with a final diagnosis of thyroid cancer. Female to male ratio was 3:1. Cytology reported as ‘malignant’ was confirmed as thyroid cancer in 100% of the cases. Of the patients, 47% with ‘suspicious’ cytology report and 14% with ‘follicular/indeterminate’ cytology report had a final diagnosis of cancer. Thyroid cancer subtypes were 90 patients with papillary thyroid cancer ‘PTC’, 24 with follicular ‘FTC’, eight with medullary ‘MTC’ and two with anaplastic cancer. Cytology was suggestive of cancer in 89% of the patients with PTC >10 mm, 75% with FTC and 88% with MTC. Transient hypocalcaemia was the commonest complication occurring in 7.2%. There were no cases of permanent hypoparathyroidism. Recurrent laryngeal nerve neuropraxia occurred in 2.4% with a permanent palsy occurring in 0.8%. There were three cancer‐related deaths. Conclusions: Preoperative synoptically reported FNAC is effective when used in diagnosing and planning surgery for thyroid cancer.     

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。     

The role of fine-needle aspiration cytology and frozen section histology in management of differentiated thyroid cancer: the UK experience

Objective: A review of the literature was undertaken to determine the use by UK surgeons of fine-needle aspiration cytology (FNAC) and frozen section histology in management of differentiated thyroid carcinoma. Results: The extent of FNAC use was highly variable, but commoner amongst more specialised surgeons who performed more than 25 thyroid operations per year. Such surgeons generally perform ipsilateral total lobectomy and isthmectomy for solitary thyroid nodule and use FNAC to assist in planning surgical strategy for differentiated thyroid cancer mainly by determining the likely extent of contralateral lobe resection and nodal dissection required. The use of frozen section histology to aid this decision intraoperatively is largely unreported in the UK literature. Received: 6 February 1998     

超声弹性成像结合免疫组织化学染色对甲状腺细针穿刺2~3级病变结节的再分析

目的探讨超声弹性成像结合免疫组织化学染色对超声引导下甲状腺细针穿刺细胞学（US-FNAC）结果为2~3级结节手术切除前进行分析的意义。 方法回顾性分析2015年1月至2017年12月,甲状腺结节手术切除患者术前US-FNAC诊断结果,根据US-FNAC结果,对2~3级病变的结节应用超声弹性成像和免疫组织化学进行分析,并与术后组织病理结果进行对比,比较US-FNAC独立诊断与US-FNAC联合超声弹性成像和免疫组织化学对甲状腺2~3级结节良恶性判断的敏感度、特异度和准确性。 结果66例患者（70个结节）为2级病变,64例患者（64个结节）为3级病变。对2~3级甲状腺结节良恶性的判断,独立诊断与联合诊断的敏感度、特异度、阳性预测值、阴性预测值、诊断准确性分别为84.75% vs 91.53%（χ²=1.297,P=0.255）、81.33% vs 92.00%（χ²=3.692,P=0.055）、78.13% vs 90.00%（χ²=3.228,P=0.072）、87.14% vs 93.24%（χ²=1.525,P=0.217）、82.84% vs 91.79%（χ²=4.851,P=0.028）,两者的诊断准确性差异有统计学意义。联合诊断与组织病理的一致性（Kappa=0.863,P<0.01）高于US-FNAC独立诊断（Kappa=0.711,P<0.01）。 结论术前应用超声弹性成像和免疫组织化学分析能提高2~3级甲状腺结节病变的诊断准确性。     

Fine-needle aspiration of the thyroid and correlation with histopathology in a contemporary series of 240 patients

BACKGROUND: False-positive, false-negative, and indeterminate fine-needle aspiration (FNA) biopsy results complicate the management of patients with thyroid nodules. METHODS: Thyroid FNA results from 240 consecutive patients (seen 1991 to 2002) were categorized into four groups: positive for malignancy, negative for malignancy, indeterminate for malignancy, and nondiagnostic. Indeterminate results included follicular neoplasm, Hürthle cell neoplasm, and suspicious for papillary carcinoma. The FNA results were compared with histopathologic analysis after thyroidectomy. RESULTS: The FNA results were 76 (32%) positive for malignancy, 53 (22%) negative for malignancy, 100 (42%) indeterminate for malignancy, and 11 (5%) nondiagnostic. There were 3 (4%) false-positive and 2 (4%) false-negative FNA results. Among the 100 indeterminate FNA results, carcinoma was found in 11 (15%) of 73 follicular neoplasms, 2 (20%) of 10 Hürthle cell neoplasms, and 14 (82%) of 17 suspicious for papillary carcinoma. For the 73 patients with follicular neoplasms, nodule diameter >2 cm was associated with an increased risk of malignancy (P <0.03). CONCLUSIONS: False-negative FNA results are uncommon, supporting the practice of observation in most of these patients. Among those with indeterminate biopsy results, high-risk subgroups include patients with FNA results suspicious for papillary carcinoma and follicular neoplasms >2 cm.