超声引导下甲状腺结节粗针穿刺活检临床应用价值

摘要

目的 探讨超声引导下甲状腺结节粗针穿刺活检(CNB)临床应用价值.方法 回顾性分析行超声引导下甲状腺结节CNB的194例患者共204个结节的超声检查资料和病理检查资料.结果 204个甲状腺结节中,193个结节穿刺成功,穿刺成功率为94.6%(193/204),无一例发生穿刺并发症.恶性结节占57.5%(111/193),其中乳头状癌占96.4%(107/111).良性结节占42.5%(82/193).恶性结节中微小结节所占比例为61.3%(68/111),高于良性结节的40.2%(33/82),且差异有统计学意义(χ2=5.7,P＜0.05).恶性结节中多结节所占比例为71.2%(79/111),低于良性结节的87.8%(72/82),但差异无统计学意义.恶性结节中微钙化所占比例为31.5%(35/111),低回声实性结节所占比例为80.2%(89/111),钙化结节所占比例为63.1%(70/111),均高于良性结节的20.7%(17/82)、63.4%(52/82)和58.5%(48/82),但差异均无统计学意义.结论 甲状腺低回声实性微小结节恶性度较高,与是否为单结节或多结节以及是否存在钙化无关.甲状腺结节超声引导下CNB是一种安全、准确的鉴别甲状腺结节良恶性的方法.%Objective To evaluate the diagnostic value of ultrasonography-guided core-needle biopsy ( US-guided CNB ) of thyroid nodules. Methods US-guided CNB was performed in a total of 204 nodules from 194 patients and all histologic results and ultrasound findings were reviewed . Results Of 204 US-guided CNB samples ,54.4% (111/204) were histologically diagnosed malignant and 40. 2% (82/204) were benign. In malignant group ,papillary carcinoma accounted for 96. 4% (107/111). The successful rate of biopsy was 94. 6% ( 193/204) and no biopsy complications took place. Compared with the proportion of micronodules (40. 2% ) in benign group , the percentage of that in malignant group (61. 3%) increased evidently(x2 = 5. 7 ,P <0. 05). The proportion of multiple nodules in malignant group (71.2% ,79/lll)was less than that ( 87. 8% , 72/82) in benign group, but the difference was not statistically significant. The proportions of microcalcification and hypoechoic solid nodules were 31.5% (35/lll)and 80.2% (89/111) , respectively in malignant group , which were higher than those (20. 7% and 63. 4% , respectively) in benign group, but the difference had no statistical significance. The proportion of calcified nodule in benign group was similar to that in malignant group (58. 5% vs 63. 1% ) with no significant difference. Conclusions Regardless of nodule number and calcification, hypoechoic solid micronodules have highly malignant possibilities. US-guided CNB is a safe and accurate diagnostic test for detecting malignant thyroid nodules .