Abstract:

Clinical application and quality control of ultrasound-guided fine-needle aspiration cytology in evaluation of thyroid nodules        ZHOU Le，ZHANG Guang，ZHANG Da-qi，et al. Department of Thyroid Surgery，China-Japan Union Hospital，Jilin University & Jilin Province Key Laboratory of Surgical Translational Medicine，Changchun 130033，China
Corresponding author：SUN Hui，E-mail：sunhui1229@163.com
Abstract    Objective    To investigate the strategy to improve ultrasound-guided fine-needle aspiration in diagnosis of thyroid nodules. Methods    A retrospective analysis of thyroid nodules diagnosed by ultrasound-guided fine-needle aspiration between May 2012 and October 2014 in Department of Thyroid Surgery，China-Japan Union Hospital，Jilin University was analyzed comparatively and chronologically. Results    A total of 7000 patients underwent puncture (7382 thyroid nodules) were enrolled. Based on the Bethesda reporting system，165 nodules were categorized as class Ⅰ(2.2%)，3202 as class Ⅱ (43.4%)，621 as class Ⅲ (8.4%)，zero as class Ⅳ，734 as class Ⅴand 2660 as class Ⅵ. A total of 2536 nodules were identified as control by post-operative histopathology，with sensitivity of 91.4%，specificity of 82.7% and false positive rate of 1.2%，respectively. When the nodules were sorted by every six months and chronologically analyzed，the sensitivity was 83%，78%，89.1%，93.1% and 96.3%，respectively；the specificity was 59%，100%，84.6%，91.7% and 97.2%，respectively. A total of 94 patients occurred local tiny hematoma during puncture，and no serious complications occurred. Conclusion    Case screening，puncture drawn，interpretation of results and other aspects of quality control contribute to improve ultrasound-guided fine-needle aspiration in diagnosis of thyroid nodules.

Key words: thyroid nodule；biopsy, fine-needle；interventional ultrasound；quality control

摘要：

目的    探讨提高超声引导下甲状腺结节细针穿刺诊断水平的策略。方法    回顾性分析吉林大学中日联谊医院甲状腺外科自2012年5月至2014年10月以超声引导下细针穿刺活检技术诊断甲状腺结节的临床资料，按时间先后分段进行分析、对比研究。结果    共穿刺7000例病人（计甲状腺结节7382个），按Bethesda报告系统其中Ⅰ类165个（2.2%），Ⅱ类3202个（43.4%），Ⅲ类621个（8.4%），Ⅳ类无，Ⅴ类734个，Ⅵ类2660个。经手术后病理学检查对照2536个，穿刺活检诊断敏感度为91.4%，特异度为82.7%，假阳性率1.2%。按时间先后每6个月计1组行分组统计，敏感度分别为83.0%、78.0%、89.1%、93.1%、96.3%，特异度分别为59.0%、100.0%、84.6%、91.7%、97.2%。穿刺过程中发生局部小血肿94例，无严重并发症。结论    超声引导下甲状腺结节细针穿刺诊断过程中病例筛查、穿刺取材、结果判读等环节的质量控制有利于该技术水平的不断提高。

关键词: 甲状腺结节, 活组织检查, 细针, 超声检查, 介入性, 质量控制