细针穿刺活检结合分子检测在甲状腺结节鉴别诊断中的研究进展

近年来,甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的发病率逐年上升,超声影像成为甲状腺癌筛查与诊断的首选检查手段。超声引导下的细针穿刺细胞学检查(ultrasound guided fine needle aspiration biopsy,US-FNAB)成为术前鉴别诊断甲状腺结节的有效微创介入方法,并通过Bethesda诊断系统分类。虽然细针穿刺细胞学检查具有较高的灵敏度和特异性,但是仍然出现诊断不明确的非典型滤泡性病变。对于此类非典型病变(Bethesda Ⅲ~Ⅴ类),US-FNAB联合基因突变检测(BRAF、RAS以及RET/PTC重排),以及miRNA分析能够显著提高不确定结节的诊断准确性,有利于临床规范化处理甲状腺良恶性结节。      

超声引导下甲状腺结节细针穿刺细胞学与粗针穿刺组织学检查的对比研究CSCD

目的比较超声引导下甲状腺结节细针穿刺细胞学与粗针穿刺组织学检查的诊断准确率、敏感度、特异性及并发症。方法收集95例超声检查疑似为恶性甲状腺结节患者的98个结节,行超声引导下细针穿刺细胞学与粗针穿刺组织学检查,并经术后常规病理检查证实。比较两种方法诊断甲状腺结节的准确率、敏感度、特异性及术后并发症。分析结节直径大小与取材满意率、诊断准确率的关系。结果 (1)细针穿刺取材满意率89.8%,粗针为96.9%。细针穿刺细胞学诊断甲状腺结节的准确率、敏感度、特异性分别为86.4%、90.5%、82.6%;粗针穿刺组织学诊断为90.5%、91.7%、88.6%;(2)粗针穿刺并发症发生率高于细针穿刺(14.3% vs.2.0%,P<0.05);(3)结节直径≥1.0 cm时,粗针穿刺诊断准确率高于细针穿刺(P<0.05)。结论细针穿刺细胞学与粗针穿刺组织学检查在甲状腺结节良恶性诊断中可互相补充。     

超声引导下甲状腺结节细针穿刺细胞学检查的应用现状

摘 要：如何精准诊断甲状腺结节的性质,以选择更加适当的治疗方法,一直是临床医师以及超声医师致力研究的问题。目前细针穿刺细胞学检查诊断甲状腺结节已经被证明是一种有效的诊断方法。文章主要就超声引导下细针穿刺细胞学检查在甲状腺结节中的应用现状进行综述。     

超声引导下甲状腺细针穿刺在鉴别甲状腺结节良恶性中的临床应用

目的 探讨超声引导下甲状腺细针穿刺(US-FNAB)在鉴别甲状腺结节良恶性中的临床应用价值及意义.方法 回顾性分析128例甲状腺结节患者的US-FNAB的细胞学诊断结果,并与手术组织病理学诊断结果对比.结果 128例甲状腺结节患者中,良性结节113例,占88.28%,其中甲状腺炎性结节所占比例较高;而恶性或可疑恶性结节12例,占9.38%.对于恶性或怀疑为恶性的甲状腺结节敏感性为85.71%,特异性为88.89%,两者总体诊断符合率为87.50%.结论 US-FNAB是一种简单准确、安全可靠的术前诊断方法,不仅提高了甲状腺恶性结节的检出率,减少了误诊率,也为手术治疗提供了重要的参考依据.     

超声引导下甲状腺细针穿刺细胞学检查(US-FNAC)在鉴别诊断甲状腺良恶性结节中的价值

目的:对比研究US-FNAC及高分辨率彩超在诊断甲状腺恶性结节中的准确率、灵敏度和特异度,了解US-FNAC在鉴别诊断甲状腺良恶性结节中的价值.方法:选取2014年3月至2015年12月在我院超声科行高频彩超及US-FNAC并入院手术的甲状腺结节患者93例,共105枚结节作为研究对象,以甲状腺结节术后病理结果为金标准,高分辨率彩超单因素Logistic回归分析结果有统计学意义的自变量及US-FNAC结果与甲状腺结节手术后的病理结果对照进行诊断性实验,了解其对甲状腺结节恶性鉴别诊断的灵敏度、特异度和准确率.结果:US-FNAC诊断甲状腺恶性结节的特异度、灵敏度及准确率分别为87.5%、96.9%和95.0%.结论:与高分辨率彩超相比,US-FNAC诊断甲状腺恶性结节具有较高的准确性,是鉴别甲状腺结节良恶性最可靠、最有价值的方法.     

细针穿刺联合分子生物标志物在甲状腺结节诊断中的研究进展

甲状腺结节常通过触诊、血清甲状腺激素、高频超声等检查来进行评估,在诊断困难时进行细针抽吸穿刺活检（FNA）来区分结节的良恶性。而大约20％的针吸细胞学不能诊断结节的良恶性。一些特异性的分子生物标志物已经应用到甲状腺结节针吸细胞学的衍生检测中并取得了相当大的进展,提高了术前诊断率。     

BRAF V600E基因检测联合细针穿刺活检对甲状腺结节良恶性诊断中的价值

  目的  探讨BRAF V600E基因检测联合超声引导下细针穿刺活检（fine needle aspiration biopsy,FNA）对甲状腺良恶性结节的临床诊断价值。  方法  选取2018年1月至2018年6月首次收入郑州大学附属肿瘤医院穿刺活检并手术的121例患者共130枚甲状腺结节,对穿刺标本行细胞学诊断及洗脱液BRAF V600E突变基因检测。  结果  130枚结节中术后病理诊断乳头状癌120枚,良性10枚,BRAF V600E基因突变检测联合FNA将细胞学诊断的敏感度由81.7%提升至92.5%,准确度由83.1%升至92.3%,差异有统计学意义（P < 0.05）。  结论  BRAF V600E基因检测联合FNA能有效提高甲状腺结节良恶性诊断的敏感度和准确度,比传统单纯细胞学诊断具有更大的参考价值。      

FNA与分子标志物联合在甲状腺结节诊断中的应用前景

随着临床检查技术的不断提高，越来越多的甲状腺结节被发现，能否明确结节性质，对下一步的临床处理有着重要意叉。就目前国内外医学技术的发展状况而言，细针吸细胞学（FNA）诊断无疑是首选方法，它具有安全、快捷、准确等特点，它与B超等技术联合可以进一步提高诊断的准确率。尤其是近年来一些特异性分子标志物的发现．显示了它在鉴别甲状腺良恶性结节方面的优势。本文着重介绍FNA与分子标志物联合在甲状腺结节诊断中的应用前景。     

细针吸取细胞学诊断甲状腺结节的探讨

目的：探讨细针吸取细胞学诊断甲状腺结节的准确性及误诊因素。方法：对3939例甲状腺结节进行了细针吸取细胞学检查，其中581例获病理组织学对照。细胞学诊断分四类：良性、恶性、可疑恶性和标本不足。结果：细胞学诊断良性占42％(248／581)，恶性占17％(98／581)，可疑恶性占29％(167／581)，标本不足占12％(68／581)。细胞学诊断敏感性为68％(95／140)，特异性为99％(438／441)。结论：仔细检查甲状腺、坚持严格的细胞学诊断标准、标本不足重复穿刺，对提高细针吸取细胞学诊断甲状腺结节的准确率有重要意义。     

细针穿刺细胞学检查与甲状腺结节的诊断

治疗前明确甲状腺结节的性质对临床处理有着非常重要的意义。细针穿刺细胞学检查对甲状腺结节具有可靠的诊断价值，超声技术的应用，电镜技术和分子诊断标记物的发展提高了细针穿刺细胞学检查在甲状腺结节中的诊断作用，现着重介绍甲状腺结节细针穿刺的方法，触诊下细针穿刺细胞学检查在甲状腺结节中的诊断价值和局限性，超声，电镜和分子诊断标记物在甲状腺结节细针穿刺细胞学检查中的应用现状。     

Evaluation of the fine needle aspiration biopsy in the preoperative selection of cold thyroid nodules

From 1980 to 1988 the authors examined by fine needle aspiration biopsy (FNAB) 4609 patients with solitary thyroid nodules or multinodular goiters. A total of 5605 "cold" thyroid nodules were evaluated and classified, on the basis of the cytologic findings, as malignant, follicular lesions (probably malignant and probably benign) and benign. Then the authors compared the preoperative cytologic findings with the postoperative histologic results in 827 nodules from patients who underwent surgery. In the 805 thyroid nodules in which an adequate cytologic specimen was obtained, false-negative results were 2.3% and false-positive findings were 1.1% By comparing cytologic and histologic diagnoses, preoperative FNAB resulted in the ability to accurately assess the risk of cancer in a thyroid nodule; since 250 nodules were identified as malignant, the risk of a "cold" thyroid nodule being cancer was 4.46% in this series.     

Fine-needle aspiration biopsy of cold thyroid nodules

This study analyzes the results of fine-needle aspiration biopsy (FNAB) of hypofunctioning thyroid nodules performed by one physician. There were 68 patients (age range, 20 to 73 years) with 83 aspirations; 30 were interpreted as positive for neoplasm (adenoma or carcinoma), 43 were negative, and ten (12%) were technically unsatisfactory. Thyroidectomy was performed on 25 patients who had positive aspirates. Subsequent morphologic study showed that 13 patients had carcinomas, ten had adenomas, and two had adenomatoid nodules (false-positive rate of FNAB for neoplasms was 8%). One of three thyroidectomy patients with negative preoperative aspirates had a carcinoma and two had adenomas (estimated minimal false-negative rate of FNAB was 9%). Nineteen patients who underwent thyroidectomies had dynamic radioisotopic thyroid angiography. There was no correlation between the pattern of vascularity and the type of neoplasm. Ultrasound (US) study was performed on 17 patients. Both adenoma and carcinoma can be solid or partially cystic. Although approximately 33% of the nodules initially diagnosed by FNAB as follicular or papillary neoplasms had different interpretations on subsequent examination of thyroidectomy specimens, 93% of the patients selected to be operated on had either adenoma or carcinoma. Thus, in this series, FNAB of cold thyroid nodules gave more useful diagnostic information than nodule size, dynamic radioisotopic scan, or US studies.     

经细针穿刺活检分析甲状腺乳头状癌恶性特征的研究

目的 探讨甲状腺超声引导下细针穿刺活检(US-FNA)分析甲状腺乳头状癌恶性特征的研究.方法 选取2018年8月至2019年1月间中国中医科学院广安门医院收治的接受US-FNA检查的50例甲状腺患者,共65个TI-RADS4类甲状腺结节.采用甲状腺超声引导下细针穿刺活检分析甲状腺乳头状癌的特征.结果 恶性甲状腺乳头状癌...     

Diagnostic accuracy and role of fine needle aspiration cytology in management of thyroid nodules

The diagnostic accuracy of fine needle aspiration cytology (FNAC) was evaluated in thyroid nodules in 100 consecutive cases, who subsequently underwent thyroidectomy between the years 1989–1991. FNAC as a diagnostic test for thyroid nodules demonstrated an accuracy of 90.9%, a sensitivity of 76.5%, a specificity of 95.9% with a false positivity of 2%, false negativity of 4%, positive and negative predictive values of 86.7% and 92.2%, respectively. A correct classification of the carcinoma type on the basis of FNAC was possible only in 69% patients. As a result, FNAC is the first line of investigation in most nontoxic nodular goiters and often the only procedure necessary to obtain an accurate diagnosis. However, it is recommended only as an adjunct to clinical judgment and is not intended to replace it. © 1995 Wiley-Liss, Inc.     

Large needle aspiration biopsy and galectin-3 determination in selected thyroid nodules with indeterminate FNA-cytology

Thyroid fine-needle aspiration biopsy (FNA)-cytology is widely used for the preoperative characterisation of thyroid nodules but this task is difficult for follicular lesions, which often remain undefined. We propose a strategy for improving the preoperative characterisation of selected follicular thyroid proliferations, which is based on large needle aspiration biopsy (LNAB) and galectin-3 expression analysis. Eighty-five thyroid specimens were obtained by LNAB (20-gauge needles) from thyroid nodules with indeterminate follicular FNA-cytology. Aspirated material was processed as a tissue microbiopsy to obtain cell blocks for both cyto/histo-morphological evaluation and galectin-3 expression analysis, by using a purified monoclonal antibody to galectin-3 and a biotin-free immunoperoxidase staining method. Preoperative diagnosis was compared to the final histology. LNAB and cell-block technique allow a preliminary distinction between nodules with a homogeneous microfollicular/trabecular structure, as frequently observed in tumours, and lesions with mixed normo-micro-macrofollicular architecture, as observed in goitre. Furthermore, LNAB provides optimal substrates for galectin-3 expression analysis. Among 85 cases tested, 14 galectin-3-positive cases were discovered preoperatively (11 thyroid cancers and three adenomas confirmed at the final histology), whereas galectin-3-negative cases were 71 (one carcinoma and 70 benign proliferations at the final histology). Sensitivity, specificity and diagnostic accuracy of this integrated morphologic and phenotypic diagnostic approach were 91.6, 97.2 and 95.3%, respectively. In conclusion, LNAB plus galectin-3 expression analysis when applied preoperatively to selected thyroid nodules candidate to surgery can potentially reduce unnecessary thyroid resections.     

乳腺癌细针穿刺的细胞形态学观察

目的 总结乳腺癌细针穿刺的细胞形态学特点及鉴别诊断.方法 观察175例乳腺癌细针穿刺的细胞学涂片与76例乳腺增生症、93例乳腺纤维腺瘤对照分析;同时观察20例细胞学漏诊和低诊乳腺癌细胞学涂片与13例细胞学过诊病例对照分析.结果 175例乳腺癌:细胞排列杂乱无极性96.6%(169/175),核间疏松排列71.4%(12...     

Aspiration needle biopsy in preoperative selection of thyroid nodules defined at fine-needle aspiration as microfollicular lesions

The palpable thyroid nodules that are diagnosed as microfollicular by fine-needle aspiration cytologic analysis are usually excised for the low probability that the nodule is a well-differentiated follicular cancer. The authors retrospectively assess the use of aspiration needle biopsy (either 16- or 18-gauge needles) in the preoperative selection of the nodules diagnosed as microfollicular at fine-needle aspiration (either 20- or 22-gauge needles). Aspiration needle biopsy is a type of large needle biopsy that is a relatively easy and innocuous method of obtaining tissue fragments for preoperative histologic examination of palpable thyroid nodules. From 1980 through 1996, 6,314 patients with palpable thyroid nodules were examined by fine-needle aspiration; 29.5% of these nodules were also examined preoperatively by aspiration needle biopsy. Of all the patients with nodules, 6% received a fine-needle aspiration diagnosis of microfollicular nodule. Two hundred sixty of the 380 nodules (68%) that were diagnosed as microfollicular at fine-needle aspiration were also examined by aspiration needle biopsy; inadequate specimens were obtained in 17% of cases; pure microfollicular structure was confirmed by aspiration needle biopsy in 35% of the nodules; and aspiration needle biopsy showed the remaining 48% to contain a macrofollicular component suggesting a benign hyperplastic lesion. Seventeen nodules that were found to be microfollicular at fine-needle aspiration cytologic analysis and micromacrofollicular at aspiration needle biopsy were excised and the postoperative result was benign in all cases. Twenty-five nodules diagnosed as microfollicular either on both fine-needle aspiration and aspiration needle biopsy were excised and the postoperative diagnoses were benign (20 nodules) or malignant (5 nodules). These data indicate that aspiration needle biopsy can be used for preoperative selection of the nodules that are microfollicular at fine-needle aspiration by identifying the nodules with high probability of being malignant and thus contributing to the reduction in the number of surgical operations for benign nodules.     

Thin core needle biopsy crush preparations in conjunction with fine‐needle aspiration for the evaluation of thyroid nodules

BACKGROUND.

Fine‐needle aspiration (FNA) is widely accepted as the initial test to evaluate thyroid nodules; however, inadequate and suboptimal specimens have been 1 of its limitations. Unsatisfactory rates of 4.1% to 43% have been reported, but suboptimal specimens with adequate epithelial cells and other limiting factors, such as clotting, often are not addressed. The authors' institution has a low unsatisfactory rate, especially for thyroid biopsies performed under ultrasound in the Interventional Radiology (IR) Department. In addition to on‐site evaluation for all cases, they concomitantly use thin, 22/20‐gauge core needle biopsy (CB) crush preparations (CP) for unsatisfactory/suboptimal FNAs. The CB usually is done after 2 FNA passes and, in most cases, is exhausted by making an air‐dried CP, which is evaluated on site for adequacy; any residual tissue is processed for tissue sections. Experience is required to interpret CP on air‐dried smears. In this report, the authors describe a complementary approach to thyroid biopsy that has worked well.

METHODS.

All thyroid FNA and CB/CP that were performed in the IR Department during the year 2005 were reviewed. Follow‐up histology and records of all procedural complications were retrieved.

RESULTS.

Seven hundred thirteen thyroid biopsies qualified, 225 biopsies (31%) had FNA with CB/CP (85% had only CP for evaluation), and 488 biopsies (69%) had only FNA. The final unsatisfactory rate in IR for FNA was 8.7%; this was reduced to 3.4% with the use of CB/CP. The addition of CB also helped to obtain a more definitive diagnosis in suboptimal FNA specimens. Cytologic‐histologic correlation was comparable for FNA only cases and FNA/CB cases. There were no significant procedural complications in CB cases.

CONCLUSIONS.

FNA in conjunction with a thin CB/CP performed during the same procedure is a safe technique that can reduce the rate of unsatisfactory and suboptimal thyroid biopsy. Cancer (Cancer Cytopathol) 2008. © 2008 American Cancer Society.