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目的研究彩超引导下细针穿刺活检(US-FNAB)在甲状腺结节诊断中的临床价值。方法在彩超引导下对41例甲状腺结节(直径0.5~1.5 cm)患者行US-FNAB,分析检查结果 ,与术后病理进行对比,从而判断US-FNAB的准确率。结果患者手术后病理结果 :甲状腺良性结节7例(结节性甲状腺肿3例,桥本氏甲状腺炎1例,腺瘤3例),其中US-FNAB诊断良性病变5例,无法判断病理类型1例,取材过少无法诊断1例。甲状腺癌34例(乳头状癌32例,髓样癌1例,滤泡性癌1例),其中US-FNAB诊断恶性结节32例,无法判断病理类型1例,取材过少无法诊断1例。US-FNAB诊断甲状腺结节准确性、敏感性分别为90.2%和95.1%。US-FNAB细胞学结果与手术病理的一致性Kappa=0.694,χ~2检验P=0.480>0.05,提示US-FNAB与手术病理结果诊断的一致性良好。41例行US-FNAB穿刺的患者均未发生出血、声音嘶哑、吞咽和呼吸困难等明显并发症。结论 US-FNAB应用于甲状腺结节的诊断准确率高,且具有操作快速、安全的特点,是诊断甲状腺结节安全有效的方法。
Objective To investigate the clinical value of fine needle aspiration biopsy (US-FNAB) in the diagnosis of thyroid nodules. Methods US-FNAB was performed in 41 patients with thyroid nodules (0.5-1.5 cm in diameter) guided by color Doppler ultrasonography. The accuracy of US-FNAB was evaluated by comparing with postoperative pathology. Results The postoperative pathological findings of the patients included 7 cases of benign thyroid nodules (3 cases of nodular goiter, 1 case of Hashimoto’s thyroiditis and 3 cases of adenoma). US-FNAB could diagnose benign lesions in 5 cases, 1 case, too few can not be diagnosed in 1 case. Thyroid cancer in 34 cases (papillary carcinoma in 32 cases, medullary carcinoma in 1 case, follicular carcinoma in 1 case), including US-FNAB diagnosis of malignant nodules in 32 cases, can not determine the pathological type in 1 case, too few can not be diagnosed in one case . US-FNAB diagnosis of thyroid nodules accuracy, the sensitivity was 90.2% and 95.1%. The consistency between US-FNAB cytology and surgical pathology was Kappa = 0.694 and χ ~ 2 test was P = 0.480> 0.05, which showed that the consistency between US-FNAB and surgical pathology was good. None of the 41 patients who underwent US-FNAB puncture had any significant complication of bleeding, hoarseness, swallowing, and dyspnea. Conclusion US-FNAB is a safe and effective method for the diagnosis of thyroid nodules because of its high diagnostic accuracy and quick and safe operation.