超声引导下细针抽吸活检对甲状腺小结节的诊断价值

目的探讨超声引导下细针抽吸活检对最大径≤10 mm甲状腺结节的诊断价值。方法回顾性分析2012年1至12月上海交通大学医学院附属瑞金医院632例患者654个最大径≤10 mm甲状腺结节的超声引导下细针抽吸活检细胞学结果。以手术病理及临床随访结果作为金标准,评价超声引导下细针抽吸活检诊断最大径≤10 mm甲状腺结节的敏感度、特异度、准确性、阳性预测值、阴性预测值。结果 654个甲状腺结节中,36个细胞学结果不满意或无诊断,361个良性,2个不典型滤泡性病变,30个可疑恶性,225个恶性。排除不满意与未手术的不典型滤泡性结节,余616个结节经手术或临床随访1年以上,最终诊断为恶性259个,良性357个。超声引导下细针抽吸活检诊断最大径≤10 mm甲状腺结节的敏感度为96.5%,特异度为98.6%,准确性为97.7%,阳性预测值为98.0%,阴性预测值为97.5%。所有患者均未见明显穿刺后并发症。结论超声引导下细针抽吸活检安全准确,是鉴别最大径≤10 mm甲状腺结节良恶性的重要方法。

The diagnostic value of ultrasound-guided fine needle aspiration biopsy in small thyroid nodules

Objective To evaluate the efficacy of ultrasound-guided fine needle aspiration biopsy（US-FNAB） in thyroid nodules ≤ 10 mm in the maximum diameter. Methods The US-FNAB results of 654 thyroid nodules ≤ 10 mm in 632 patients were retrospectively analyzed from January 2012 to December 2012 at Rui Jin Hospital. Using pathology and clinical course as gold standard, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of US-FNAB were evaluated. Results Of 654 nodules, 36 were classified as unsatisfactory, 361 as benign, 2 as undetermined, 30 as suspicious, and 225 as malignant. Unsatisfactory and undetermined nodules without surgical treatment were excluded. Of the remaining 616 nodules, 259 malignant and 357 benign nodules were eventually diagnosed by surgery or clinical follow-up for more than one year. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of US-FNAB for thyroid nodules≤10 mm were 96.5%, 98.6%, 97.7%, 98.0% and 97.5% respectively. No apparent biopsy-related complication was found. Conclusion US-FNAB is a safe and effective method for the diagnosis of thyroid nodules ≤ 10 mm in the maximum diameter.