快速细胞学检测方法术中鉴别与保护甲状旁腺的临床意义

目的:探讨术中快速鉴别并保护甲状旁腺的新方法。方法:纳入11例2017年7月至2017年8月期间西京医院初诊收治的甲状腺癌患者。术中行淋巴结清扫时，如若遇到可疑甲状旁腺，首先由手术主刀医师按照临床经验肉眼观察，判断为甲状旁腺或非甲状旁腺并予以记录。随后，对可疑甲状旁腺进行甲状旁腺示踪，细针穿刺少量组织，进行Diff-Quik快速细胞学检测，根据甲状旁腺的细胞学特征判定是否为甲状旁腺。最后将可疑甲状旁腺少量取材送快速冰冻病理，以冰冻病理结果为金标准评价医师主观判断以及细胞学检测术中鉴别可疑甲状旁腺的诊断价值。结果:术中共发现21个可疑甲状旁腺，冰冻病理检测有1个结节因取材不足无法进行检测。以冰冻病理结果为金标准，肉眼经验性评判准确性为60.0%，敏感性为100.0%，特异性为11.1%，kappa值为0.121，AUC面积仅为0.554，95%CI（0.283~0.828）。快速细胞学检测有2个因术中细针穿刺样本不足被剔除，剩余18个结节鉴定准确性为94.4%，敏感性为100.0%，特异性为88.9%，kappa值为0.889，AUC面积为0.944，95%CI（0.819~1.000）。结论:术中快速细胞学检测可有效提高甲状旁腺鉴别的准确性与特异性，具有较高临床诊断价值。

Rapid cytological detection method for intraoperative identification and protection of parathyroid glands

Objective:To explore a new method for intraoperative identificattion of parathyroid glands.Methods:Eleven patients，who would achieve thyroidectomy with neck dissecttion，admitted to our hospital between July 2017 and August 2017 were enrolled into the study.During lymph node dissection，the suspicious glands were justified based on the subjective judgement of clinician，and then cytological rapid detection method.Frozen pathology outcome was regarded as golden standard.The diagnostic value was evaluated and compared between clinician identification and cytological detetection.Results:Twenty-one suspicious parathyroid glands were found by the clinician.Except for one node failed for frozen pathology detection becasuse of insufficient sample，the remaining 20 glands were identified their characteristics.Statistical analysis showed that the accuracy，sensitivity and specificity rate，between experimental judgement and cytological detection，were 60.0% vs 94.4%，100.0% vs 100.0% and 11.1% vs 88.9%.Consistency analysis demonstrated that the kappa value was 0.121 vs 0.889，AUC area was 0.554，95%CI（0.283~0.828） vs 0.944，95%CI（0.819~1.000）.Conclusion:Intraoperative cytological detection method improved the accuracy and specificity of parathyroid identification，possessing the diagnostic significance.