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本文报导我院1984年1月—1996年12月期间误诊的分化型甲状腺癌54例。该型甲状腺癌误诊率高,本组占同期甲状腺癌的28.09％(54/190)。误诊原因与临床医生警惕性不高、影像学检查无特异性和细胞及病理学检查的某些缺陷等因素有关。而寻求合理准确的细胞及病理学检查是降低误诊率的关键。本组资料表明,对甲状腺肿块术前常规作细针抽吸细胞学检查(FNAC),可显著降低误诊率;FNAC有一定的假阴性率,采用专人检查、规范操作、重复检查等措施有助于克服这一不足;此外应积极行术中冰冻切片(FS),如与FNAC相结合,可大大降低误诊率。为避免再手术,应尽可能术前明确诊断以指导术式选择。废弃肿块剜出术,注意术中颈淋巴结探查。
This article reports 54 cases of differentiated thyroid cancer misdiagnosed in our hospital from January 1984 to December 1996. The misdiagnosis rate of this type of thyroid cancer is high. This group accounted for 28.09% (54/190) of thyroid cancer in the same period. The reasons for misdiagnosis are related to factors such as low clinician vigilance, non-specific imaging findings, and certain defects in cellular and pathological examinations. The search for reasonable and accurate cell and pathological examination is the key to reduce the misdiagnosis rate. The data in this group showed that routine preoperative fine needle aspiration cytology (FNAC) can significantly reduce the misdiagnosis rate; FNAC has a certain false negative rate, the use of special inspection, standardized operation, repeated inspections and other measures will help To overcome this deficiency; In addition, active frozen section (FS) should be used, if combined with FNAC, can greatly reduce the misdiagnosis rate. In order to avoid reoperation, a clear diagnosis should be made as far as possible before surgery to guide the choice of surgery. Discarded lumpectomy, attention to intraoperative cervical lymph node exploration.