甲状腺结节细针穿刺活检的细胞病理学诊断进展

细针穿刺细胞学检查(FNAB)是目前甲状腺结节术前诊断的一个常用手段。本文讨论了穿刺细胞学中超微病理学检查的应用价值以及甲状腺特异性基因、癌基因、抑癌基因和某些与调控细胞周期和功能有关的蛋白质在甲状腺肿瘤发展中的作用。常规细胞学诊断结合电镜和与甲状腺肿瘤形成有关的分子诊断标志物检查有助于确诊率的提高。     

彩超导向与触诊针吸术在甲状腺结节诊断中的价值比较

将200例甲状腺结节患者随机分为观察组和对照组各100例,分别行彩超引导下细针针吸术及触诊细针针吸术,将其诊断结果与术后病理结果进行比较。结果结节直径〉2cm者观察组准确性、取材阳性率率高于对照组,结节≤2cm者观察组敏感性、特异性、准确性与取材阳性率均高于对照组。认为彩超引导下细针针吸术对甲状腺结节诊断优于触诊针吸术。     

甲状腺结节细针穿刺活检的细胞病理学诊断进展

细针穿刺细胞学检查(FNAB)是目前甲状腺结节术前诊断的一个常用手段。本文讨论了穿刺细胞学中超微病理学检查的应用价值以及甲状腺特异性基因、癌基因、抑癌基因和某些与调控细胞周期和功能有关的蛋白质在甲状腺肿瘤发展中的作用。常规细胞学诊断结合电镜和与甲状腺肿瘤形成有关的分子诊断标志物检查有助于确诊率的提高。     

甲状腺结节和肿瘤的诊断、治疗与展望

简要讨论甲状腺结节和甲状腺肿瘤的定义和分类，及细针抽吸细胞学检查、核素扫描和超声等检查在其诊断及指导治疗中的价值。评述甲状腺结节和甲状腺肿瘤的治疗原则及最新进展。     

超声诊断甲状腺结节的临床应用规范化

美国甲状腺学会(ATA)将甲状腺结节定义为甲状腺内散在病灶,触诊和(或)超声能将其和周围甲状腺组织清楚分界,但2009年ATA发布的指南则将触诊和(或)超声改成了影像学,去掉了触诊,表明影像学检查尤其是超声检查在甲状腺结节诊断中的重要地位.1 临床评估与处理中的应用在超声应用于甲状腺检查之前,甲状腺结节的检查主要靠触诊.直径＞1cm的结节通常可触及,而超声检查甲状腺结节的检出率(67％)明显高于触诊(21％),且20％ ～ 48％临床上触及甲状腺结节的患者通过超声检查可发现额外的结节.另外,可利用超声确定哪些结节需超声引导下行细针抽吸活检(FNA).因此,超声已成为临床评估和处理甲状腺结节的基石.     

超声引导下抽吸式组织活检针在甲状腺结节活检中的应用

目的：评估超声引导下抽吸式组织活检针在甲状腺结节活检中的临床应用价值。方法选择甲状腺结节患者126例,随机均分为对照组和观察组。观察组在超声引导下使用抽吸式组织活检针行甲状腺结节活检。对照组行切割式组织活检针穿刺活检。观察两组活检耗时、手术成功率及并发症等,并与术后病理结果进行比较。结果与对照组比较,观察组穿刺时间短、穿刺成功率高,周围重要组织伤害例数少（P均＜0．05）。观察组诊断符合率为95．2％、灵敏度为96．7％、特异度为93．9％、误诊率为6．1％、漏诊率为3．3％,对照组分别为93．7％、93．8％、93．5％、6．5％、6．2％,两组比较P均＞0．05。结论超声引导下抽吸式组织活检针穿刺成功率高,安全可靠,值得临床推广。     

细针穿刺细胞学与甲状腺结节鉴别诊断

甲状腺结节是常见的甲状腺疾病,正确区分其良、恶性为治疗关键.细针穿刺细胞学检查在甲状腺结节的鉴别诊断中发挥了重要作用,在其基础上,应用分子诊断、多基因检测及基凶芯片等现代技术可进一步提高诊断的准确率,对于明确诊断、减少治疗费用、指导外科治疗具有极大作用.现丰要就细针穿刺细胞学用于甲状腺结节的鉴别诊断作相关阐述.     

常规超声与B超引导下穿刺细胞学检查在诊断小病灶甲状腺结节中的对比

目的探讨超声引导下细针穿刺细胞学检查应用于小病灶甲状腺结节诊断的价值。方法小病灶甲状腺结节患者80例,对研究对象进行超声引导下细针穿刺细胞学检查和超声检查。以手术病理学检查或者随访结果作为金标准,判定超声引导下细针穿刺细胞学检查和超声检查对于小病灶甲状腺结节诊断的灵敏度和特异度。结果超声引导下细针穿刺细胞学检查结果显示,患者中良性56例,恶性15例,可疑恶性5例,取材不满意4例。金标准检查结果证实,良性结节62例,恶性结节18例。排除4例取材不满意的患者,超声引导下细针穿刺细胞学检查诊断灵敏度为98.75%,特异度为96.67%,超声检查的灵敏度为72.22%,特异度为96.36%,超声引导下细针穿刺细胞学检查的灵敏度和特异度均显著高于超声检查(P<0.05)。结论超声引导下细针穿刺细胞学检查对小病灶甲状腺结节具有较高的诊断灵敏度和特异度,值得推广应用。     

甲状腺细针穿刺活检及细胞学检查

细针穿刺活检细胞学检查对许多甲状腺疾病具有可靠的诊断价值。本文简要介绍甲状腺穿刺活检的历史、细针穿刺方法及甲状腺细胞学表现的组织病理基础，详细介绍各种甲状腺炎、甲状腺功能亢进症、甲状腺肿、甲状腺囊性病变、甲状腺腺瘤、各种甲状腺癌及甲状腺髓样癌的细胞学特点。     

甲状腺结节60例细针抽吸细胞学与病理检查的对照分析

目的 :探讨细针抽吸细胞学检查对甲状腺结节性质的诊断价值。方法 :对 6 0例甲状腺结节患者均行细针抽吸细胞学检查 ,而后行手术治疗及病理检查 ,并将两种方法进行对照分析。结果 :6 0例甲状腺结节中 ,细针抽吸结果 :良性 86 .7% ,恶性 13.3% ;手术病理结果 :良性 81.7% ,恶性 18.3%。二者相对照 ,诊断符合者 5 5例 ,诊断符合率为 91.7% ,不符合者 5例 ,其中 3例甲状腺恶性肿瘤误为良性病变。结论 :细针抽吸细胞学检查对甲状腺结节的诊断有一定的参考价值     

用针刺吸引细胞学方法在地方性甲状腺肿患者中筛查甲状腺癌的报告

本文报告了对在新疆和田、墨玉、洛浦三县地甲病严重流行区内的2015例维吾尔族农民地方性甲状腺肿患者用甲状腺针吸细胞学检查的筛查结果,甲状腺癌的并发率为6.05％。对患者的性别、年龄、腺肿类型、程度、界线、软硬度及活动性等临床表现与恶性、间变、良性细胞的检出率等病理资料进行了比较。对地方性甲状腺肿患者中甲状腺癌的井发率、甲状腺癌的临床指征、甲状腺针吸细胞学检查方法的准确性、安全性和实用价值进行了讨论。作者认为,甲状腺针吸细胞学检查方法,对于诊断和鉴定地方性甲状腺肿病的良恶性,为早期发现和治疗甲状腺恶性肿瘤是一种好方法,适用于地甲病流行区的普查普治工作。     

Histology Combined with Cytology by Endoscopic Ultrasound-Guided Fine Needle Aspiration for the Diagnosis of Solid Pancreatic Mass and Intra-Abdominal Lymphadenopathy

Background/Aims

Small core biopsy samples can occasionally be obtained with conventional endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA). Although most studies have focused on the cytological analysis of specimens, data regarding histological assessment is scarce. The aim of this study was to determine whether core biopsies by conventional EUS-FNA could increase the accuracy of EUS-guided sampling when combined with cytology in the absence of an on-site cytopathologist.

Methods

In the 95 consecutive patients (98 lesions) undergoing EUS-FNA of solid pancreatic masses and intra-abdominal lymphadenopathy, tissue coils from the needle were harvested for histology, and residual tissue was examined by cytology.

Results

Adequate samples were obtained by EUS-FNA cytology, histology, and combined cytology-histology in 91.8%, 65.3%, and 94.8% of patients, respectively. From the pancreas (n=67), adequate samples for histology were obtained by EUS-FNA in 68.7% of cases, compared with 58.0% from non-pancreatic cases (n=31), respectively (p>0.05). The overall sensitivity and accuracy of EUS-FNA was 78.0% and 81.6% for cytology alone, 63.4% and 69.4% for histology alone, and 84.1% and 86.7% for combined cytology-histology, respectively.

Conclusions

Combined cytology and histology analysis for diagnosing pancreatic masses and intra-abdominal lymphadenopathy may increase the diagnostic yield of conventional EUS-FNA without on-site cytology.     

Colonoscopic Fine Needle Aspiration Cytology in the Diagnosis of Ileocecal Tuberculosis

Two cases of ileocecal tuberculosis are presented. The diagnosis was achieved by endoscopic fine needle aspiration cytology (FNAC), while endoscopic biopsies and brush cytology were negative. The usefulness of endoscopic FNAC in the diagnosis of gastrointestinal tract tuberculosis is highlighted.     

Fine - Needle Aspiration Biopsy Smears in the Diagnosis of Liver Diseases

The different opinions concerning the value of fine-needle biopsy may partly be explained by divergencies in results between examiners. 103 coded fine-needle aspiration biopsy smears were stained by the May-Grünwald-Giemsa's method and examined independently by two investigators by light microscopy. Complete agreement in classification or slight disagreement occurred in 94–98% of the smears for recognition of the degree of vacuolization, granulation, bile accumulation, and nuclear size variation. Similar results were obtained in 83 and 90% for bile epithelium and connective tissue, respectively. Correlation between the clinical diagnoses and the cytological alterations did not show any characteristic ‘profile'. In 5 cases with acute alcoholic hepatitis and in patients with cirrhosis and chronic hepatitis high grades of bile duct epithelium were present. A correct diagnosis of liver cancer was made by both examiners in the same percentage of cases in the smears as in the conventional liver biopsies.     

CT引导下经皮肺细针抽吸活检术的临床应用

目的探讨CT引导下经皮肺细针抽吸活检术的临床应用。方法对30例经影像检查考虑为肺部肿瘤患者,在CT引导下经皮肺细针抽吸活检术。结果30例活检中肺癌24例,转移癌2例,肺结核2例,诊断准确率93．3％（28／30）,并发症很少,其中气胸2例,痰中带血3例。结论CT引导下经皮肺细针抽吸活检术定位准确,诊断率高,并发症少,操作安全,是一种可靠的肺部疾病的诊断技术。     

促甲状腺激素受体抗体（TRAb）检测在甲状腺疾病鉴别诊断中的应用

目的分析血清促甲状腺激素受体抗体（TRAb）测定在甲状腺疾病临床诊断中的应用价值。方法采用放射受体分析和放射免疫分析法,测定373例甲状腺疾病患者血清TRAb和T3、T4、TSH、FT3、FT4含量,并根据以上参数的含量为标准,把患者分为单纯性甲状腺肿组、桥本氏病组、原发性甲减组、甲状腺功能亢进（甲亢）组、药物性甲减组,以45例非甲状腺疾病血清中TRAb和T3、T4、TSH、FT3、FT4含量作为对照组。结果单纯性甲状腺肿组、桥本氏病组血清TRAb含量与正常对照组无差异（χ^2=0.462,P〉0.05）;甲亢组、原发性甲减组血清TRAb含量明显高于正常对照组（χ^2=17.035,P〈0.01）;药物性甲减组血清TRAb含量与甲亢组差异显著（χ^2=4.804,P〈0.05）,与正常组比较亦有显著性差异（χ^2=9.071,P〈0.05）;血清TRAb含量与各组间T3、T4、FT3、FT4及TSH浓度之间无显著相关性（χ^2=0.325,P〉0.05）。结论血清TRAb含量的监测对甲状腺疾病的诊断、鉴别诊断、疗效观察等具有临床应用价值。     

Epidemiologic Analysis of Thyroid Fine Needle Aspiration Biopsies over a Period of 18 Years (1987-2004).

INTRODUCTION: Fine Needle Aspiration Biopsy (FNA) is a method widely used in the assessment of thyroid nodules. The main aim of this 18-year retrospective study was the investigation of the diagnostic value of FNA cytology in thyroid malignancy. SUBJECTS AND METHODS: We retrospectively reviewed 1376 patients who underwent 1938 FNAs from 1987 to 2004 in the Department of Endocrinology, "Hippokration" General Hospital, Thessaloniki, Greece. Of them 178 subsequently underwent total or subtotal thyroid resection and a pathology report was available. RESULTS: FNA cytology shows a sensitivity of 76.2% and a specificity of 90.5% for thyroid malignancy, with a significant agreement between FNA cytology and the histology following resection surgery (Cohen's method, p<0.05). There was a considerable improvement in the diagnostic value of FNA cytology during the sub-period 1996-2004 as compared to the sub-period 1987-1995. CONCLUSIONS: 1) FNA is a reliable diagnostic method in the assessment of thyroid malignancy, 2) a non-diagnostic FNA should always be repeated, 3) meticulous follow-up is mandatory, even after a cytological result of benign hyperplasia and 4) increased experience can improve the diagnostic value of FNA in thyroid malignancy.     

Utility of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of tuberculous lymphadenitis compared to GeneXpert in a tertiary health care center in Northern Odisha,India

BackgroundDiagnosis of extrapulmonary tuberculosis including tuberculous lymphadenitis (TBLN) is challenging because of its atypical clinical presentation, paucibacillary nature of mycobacteria at the infected sites, variation in sensitivity of a test to specimens collected by different methods and from different infected tissues.MethodsIn the present study, suspected individuals for lymph node tuberculosis irrespective of age were enrolled prospectively and specimens were collected aseptically by fine needle aspiration (FNA). After the implementation of exclusion criteria, FNA specimens from a total of 278 cases of suspected TBLN were evaluated for cytomorphology (FNAC), presence of acid-fast bacillus (AFB) in smear microscopy and specific detection of mycobacterial DNA in cartridge-based nucleic acid amplification test (CBNAAT).ResultsThe results showed high prevalence of Type II (59.71%), followed by Type I (34.53%) and Type III (5.75%) pattern in FNAC. Non-type II patterns were significantly high in regions outside of the head and neck region (P = 0.031; OR = 2.125) and had an increasing trend of their occurrences with progression of age. The most affected age group was between 16 and 30 years with female preponderance documented in individuals below 45 years, whereas male preponderance was observed in higher age group patients, majority of whom had infected lymph nodes outside of HAN region (P = 0.063, OR = 1.998). The results also showed high sensitivity of CBNAAT (83.04%) method followed by FNAC (72.17%) with AFB smear exhibiting the disappointing results (sensitivity of 10.86%) compared to the CRS. High percentage of positivity was observed in Type III (AFB:25% vs CBNAAT: 100%) followed by Type II (AFB:10.2 vs CBNAAT: 76.5), while low detection was observed from samples with Type I (AFB:4.2 vs CBNAAT: 50). Interestingly, CBNAAT detection of TB was shown to be unaffected by gender, age and site of infection.ConclusionThe study suggests a possible contributary role of age and gender for cytomorphological pattern distribution of TBLN at various body parts. Although FNAC detected TB in 77.1% of cases which were identified positive by CBNAAT and/or AFB, it is being solely based on cytomorphology cannot be used alone as a reliable diagnostic method for TBLN detection. Further, the negative results in CBNAAT for FNAC positive cases may not necessarily be non-TB cases and must be evaluated by other diagnostic modalities. We recommend for both cytomorphological investigation and CBNNAT for the fine needle aspirates from suspected TBLN and subsequent treatment to reduce the disease burden.