协和医学杂志

2014, v.5(01) 8-12

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薄层液基细胞学涂片在超声引导下甲状腺细针抽吸活检的应用
Application of a Thin-layer Liquid-based Technique in Ultrasound-guided Fine Needle Aspiration of Thyroid

李文波;朱庆莉;姜玉新;戴晴;孙健;张波;杨萌;
LI Wen-bo;ZHU Qing-li;JIANG Yu-xin;DAI Qing;SUN Jian;ZHANG Bo;YANG Meng;Department of Ultrasound,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

摘要(Abstract):

目的探讨薄层液基细胞学涂片技术在超声引导下甲状腺穿刺中的应用价值。方法 2008年1月至7月57例患者的57个甲状腺病变进行超声引导下细针抽吸细胞学检查并同时进行薄层液基细胞学涂片。其中14例获得手术病理,其余病例全部进行临床随访,随访时间5年至5年6个月。细胞学及组织学诊断结果分为四类:良性、恶性、可疑恶性及涂片不满意,将其与手术病理及临床随访结果进行对照分析,分析薄层液基细胞学涂片的细胞学特征及对甲状腺结节的诊断价值。结果薄层液基细胞学涂片与常规细胞学涂片特征有一定差异,主要表现在背景血细胞明显减少、细胞量较多、集中,胶质量少或浓集、核较深染、细胞皱缩更常见、常见细胞质碎片及裸核。57个甲状腺病变中,经手术病理及临床随访证实恶性6个,良性51个。薄层液基细胞学涂片诊断良性48个(84.2%),恶性4个(7.0%),涂片不满意5个(8.8%)。该技术诊断甲状腺恶性结节的敏感性66.7%,特异性100%,准确率94.5%,阳性预测值100%,阴性预测值96.2%。与常规细胞学涂片诊断结果相似。结论薄层液基细胞学涂片细胞学特征与常规涂片有一定差异,诊断准确性与常规涂片相似,在甲状腺结节细针抽吸细胞学检查中有较好的应用价值。
Objective To investigate the usefulness of the thin-layer liquid-based cytology in ultrasoundguided fine needle aspiration( UG-FNA) of thyroid gland lesions.Methods From January 2008 to July 2008,57 thyroid lesions from 57 patients aged from 18 to 78 in Peking Union Medical College Hospital were sampled by ultrasound-guided fine needle aspiration.The cytologic materials were prepared for both conventional and thinlayer liquid-based cytology by PRPSTAIN Processor( Tripath Imaging,BD,USA).All cytological diagnoses were compared with those confirmed by surgical pathology and clinical follow-up.The UG-FNA results were classified as benign,malignant,suspicious,or unsatisfactory.The various cytologic features on liquid-based cytology and conventional preparation were compared.Results Cytomorphologic features showed some differences between the two methods.Liquid-based cytology slides had a clear background and less or dense colloid.It dem-onstrated more cell shrinkage and showed increased disruption of the cytoplasm and numerous naked nuclei.Among the 57 thyroid lesions,surgical pathology and clinical follow-up confirmed that 6 were malignant and 51 were benign.The thin-layer technology showed that 48( 84.2%) were benign,4( 7.0%) were malignant,and 5( 8.8%) were unsatisfactory for interpretation.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value were 66.7%,100%,94.5%,100%,and 96.2%,respectively,which were similar with conventional method.Conclusions Liquid-based cytology technique has certain different cellular features when compared with conventional smears but with similar diagnostic accuracy.It is an accurate and reliable method for the preoperative cytological diagnosis of thyroid nodules.

关键词(KeyWords): 甲状腺;超声引导;细针抽吸;薄层液基细胞学
thyroid;ultrasound-guided;fine needle aspiration;thin-layer liquid-based cytology

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基金项目(Foundation): 国家高技术研究发展计划(863计划)(2006AA02Z4B3);; 国家自然科学基金(81171354);; 北京市科技新星计划(Z131107000413063)

作者(Author): 李文波;朱庆莉;姜玉新;戴晴;孙健;张波;杨萌;
LI Wen-bo;ZHU Qing-li;JIANG Yu-xin;DAI Qing;SUN Jian;ZHANG Bo;YANG Meng;Department of Ultrasound,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

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