超声引导下粗针穿刺活检对甲状腺结节诊断价值的临床研究

目的回顾性分析大样本甲状腺结节超声引导下粗针穿刺活检（CNB）的结果，并评价其诊断价值。 方法2009年4月到2011年4月在解放军总医院超声诊断科行CNB的355个患者的369个结节纳入本研究。恶性结节以手术切除后组织病理学结果为诊断金标准。良性结节以手术切除后组织病理学结果或者粗针穿刺活检良性且随访至少3年无明显变化为标准。采用甲状腺针吸细胞学检查Bethesda分级标准，得出CNB诊断不明确的比率。计算CNB诊断的敏感度、特异度、阳性预测值、阴性预测值和准确性，计算受试者工作特性（ROC）曲线下面积。分析CNB诊断效果与结节声像图特征的相关性。 结果CNB结果中22（6.0%）个结节诊断不明确。CNB诊断的敏感度、特异度、阳性预测值、阴性预测值和准确性分别为97.7%，98.5%，99.1%，96.3%和98.0%。ROC曲线下面积为0.981±0.009（95%可信区间：0.964~0.998）。 结论超声引导下CNB对甲状腺结节诊断的准确性高，安全性好，可减少重复穿刺、诊断性手术和不必要的随访。CNB的诊断效果不受结节声像图表现的影响。因此，具有可疑恶性征象的甲状腺结节，超声引导下CNB可作为穿刺活检的方法。

The value of ultrasound guided core needle biopsy for the diagnosis of thyroid nodules

ObjectiveTo evaluate the diagnosis value of ultrasound guided core needle biopsy (CNB) of thyroid nodules based on large sample retrospective analysis. MethodsFrom April 2009 to April 2011, 369 thyroid nodules from 355 patients underwent ultrasound guided CNB in our department and were included in our research. Final diagnosis was provided by surgical pathological results for malignant nodules or by at least 3 years follow up for benign nodules. Bethesda classification of fine needle aspiration was used for determination. The inconclusive rates of CNB were evaluated. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and the receiver operating characteristic (ROC) curve of CNB were calculated. The correlations of CNB results with final diagnosis and ultrasound characteristics were summarized. ResultsThe inconclusive result occurred in 22 (6.0%) nodules. The sensitivity, specificity, PPV, NPV, accuracy and area under the ROC curve of CNB were 97.7%, 98.5%, 99.1%, 96.3%, 98.0% and 0.981±0.009 (95%CI 0.964-0.998). ConclusionUltrasound-guided CNB had high rates of conclusive and accurate diagnosis in thyroid nodules. It could reduce repeat FNA, diagnostic surgery and unnecessary follow-up. US characteristics did not affect the diagnostic value of CNB. Ultrasound-guided CNB can also be served as the first-line diagnostic tool for thyroid nodules with suspicious Ultrasound- findings.