目的:探讨超声引导下两种穿刺方法对巨大甲状腺结节良恶性的诊断价值.方法:选择直径超过10mm的甲状腺结节患者50例,在超声引导下行细针抽吸细胞学和粗针穿刺组织学检查,对比分析两种检查手段与术后病理检查结果的符合率等.结果:超声引导下粗针穿刺组织学与术后病理检查的符合率为92.0%,明显高于细针抽吸细胞学检查(78.0%),差异有统计学意义(P<0.01);超声引导下粗针穿刺组织学诊断巨大甲状腺结节良恶性的特异度为78.57%,明显高于细针抽吸细胞学检查(52.63%),差异有统计学意义(P<0.01);且阳性预测值(92.11%)亦高于细针抽吸细胞学检查(76.32%),差异也有显著统计学意义(P<0.01).两种检查手段诊断的敏感度和阴性预测值均无明显差异(P>0.05).结论:相比超声引导下细针抽吸细胞学检查,粗针穿刺组织学对巨大甲状腺结节良恶性的诊断价值更高,其诊断敏感度和阴性预测值更高.%Objective:To compare the value of two kinds of puncture methods by ultrasound-guidedfor the diagnosis ofgiant benign and malignant thyroid nodules.Methods :50 cases of thyroid nodules bigger than 10mm in maximum diameter were selected and were examined by both in the ultrasound guided fine needle aspiration cytology and coarse needle aspiration biopsy and two kinds of examination methods in the diagnostic coincidence rate with postoperativepathological diagnosisrate were compared.Results:The diagnostic coincidence rate with postoperative pathological examination ofultrasound-guided coarse needle aspiration biopsy (92%) was significantly higher than that of the fine needle aspiration cytology (78%) (x2=12.43,P<0.01).The specificity of ultrasound-guided coarse needle aspiration biopsy in the diagnosis of giant benign and malignant thyroid nodules (78.57%) was obviously higher than that of the fine needle aspiration cytology (52.63%) (x2=21.69,P<0.01) and the positive predictive value (92.11%) was also higher than that of the fine needle aspiration cytology (76.32%) (x2=9.96, P<0.01).The sensitivity and negative predictive value showed no significant difference between the two kinds of examination methods (P>0.05).Conclusion:Compared with ultrasound-guided fine needle aspiration cytology, ultrasound-guidedcoarse needleaspiration biopsy has greater value in the diagnosis ofgiant benign and malignant thyroid nodules, which has higher diagnostic sensitivity and negative predictive value.
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