中国实用外科杂志

中国实用外科杂志

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细针穿刺甲状腺球蛋白检测对甲状腺乳头状癌颈淋巴结转移诊断价值探讨

杨汶士，张    艳，龙厚隆，张凤凤，王思雷，刘    斌，李    峰   

  1. 滕州市中心人民医院乳腺甲状腺外科，山东滕州277500
  • 出版日期:2017-09-01 发布日期:2017-09-05

  • Online:2017-09-01 Published:2017-09-05

摘要：

目的    探讨细针穿刺甲状腺球蛋白（FNA-Tg）检测对甲状腺乳头状癌（PTC）颈淋巴结转移的诊断价值。方法    选取2013年9月至2015年9月滕州市中心人民医院接受手术治疗的PTC病人41例，术中快速病理学检查证实为甲状腺乳头状癌（PTC）并行颈淋巴结清扫，清扫标本中解剖分离淋巴结，任意选取152枚淋巴结行细针穿刺，穿刺物涂片，由细胞病理学医师诊断；另取穿刺物，将其反复冲洗至0.5 mL生理盐水EP管内，电化学发光免疫分析法（ECLIA）定量球蛋白（Tg），以组织病理学诊断为金标准，对比分析两种检测方法对PTC颈部淋巴结转移的诊断价值。依据血清甲状腺球蛋白抗体（S-TgAb）检测值将PTC病人分为阳性组、阴性组，对比分析S-TgAb对FNA-Tg的影响。结果    FNA-Tg诊断PTC颈部淋巴结转移的敏感度、特异度、准确率分别为95.3%、95. 5%、95.4%；细针穿刺细胞学检查（FNAC）敏感度、特异度、准确率分别为84.4%、86.4%、85.5%，差异有统计学意义；S-TgAb对FNAB-Tg诊断颈淋巴结转移影响显示P=0.415，差异无统计学意义。结论    FNA-Tg检测可提高PTC颈淋巴结转移的诊断准确率，且不受S-TgAb的影响，可广泛应用于临床，对甲状腺癌病人分期及诊疗方案的确定具有重要意义。

关键词: 甲状腺乳头状癌, 细针穿刺, 细胞学, 甲状腺球蛋白

Abstract:

The diagnosis value of fine-needle aspiration thyroglobulin testing in cervical lymph node metastasis of papillary thyroid carcinoma    YANG Wen-shi,ZHANG Yan，LONG Hou-long, et al. Department of Breast and Thyroid Surgery, the Central People's Hospital of Tengzhou, Tengzhou 277500, China
Corresponding author:LI Feng, E-mail：2117001383@qq.com
Abstract    Objective    To investigate the value of fine needle aspiration thyroglobulin （FNAB-Tg） testing in cervical lymph node metastasis of papillary thyroid carcinoma. Methods    A total of 41 patients with thyroid cancer underwent surgical treatment from September 2013 to September 2015 in the Central People's Hospital of Tengzhou. Intraoperative rapid pathologically confirmed PTC parallel neck dissection was performed. A total of 152 lymph nodes from dissection specimens were arbitrarily selected to fine needle aspiration biopsy，then biopsy needle content was expelled onto a slide and smeared using a second slide， which were read by an experienced cytopathologist. Another biopsy tissue was repeatedly washed with 0.5mL of normal saline in EP tube， using ECLIA quantitative Tg. The dissected nodes were send to histopathologic diagnosis as the gold standard. The value of the two methods were compared in the diagnosis of cervical lymph node metastasis of thyroid cancer. PTC patients were divided into positive and negative groups based on values of serum thyroglobulin antibody （serum thyroglobulin antibodies， S-TgAb）. The impact of S-TgAb to FNAB-Tg was analyzed comparatively. Results    The sensitivity，specificity and the diagnosis accurate rate of cervical lymph node metastasis in thyroid cancer diagnosis by FNAB-Tg were 95.3%, 95.5%, 95.4%, respectively.Those of fine needle aspiration cytology （FNAC） were 84.4%, 86.4%, 85.5%，respectively. The difference had significance statistically. The influence of S-TgAb on FNAB-Tg diagnosis of cervical lymph node metastasis displayed P=0.415＞ 0.05，and the difference had not significance statistically. Conclusion  FNA-Tg can improve the diagnostic accuracy of PTC lymph node metastasis， and is not affected by S-TgAb，which can be widely used in clinic to determine the staging and treatment programs of thyroid cancer .

Key words: papillary thyroid carcinoma, fine needle aspiration, cytology, thyroglobulin