【摘要】：目的：通過對大樣本量甲狀腺結(jié)節(jié)的細(xì)針穿刺細(xì)胞學(xué)檢查結(jié)果及病理學(xué)結(jié)果分析，探討二種不同穿刺方法的臨床應(yīng)用價(jià)值；甲狀腺結(jié)節(jié)大小對穿刺細(xì)胞學(xué)檢查的影響及穿刺細(xì)胞學(xué)檢查對甲狀腺結(jié)節(jié)良、惡性的診斷價(jià)值。 方法：選取2011年5月-2014年2月于我院行甲狀腺結(jié)節(jié)細(xì)針穿刺細(xì)胞學(xué)檢查的2574例患者共3000個(gè)甲狀腺結(jié)節(jié)。所有結(jié)節(jié)均經(jīng)手術(shù)病理或穿刺活檢病理證實(shí)。在3000個(gè)結(jié)節(jié)的穿刺過程中，采用目前常用的二種的穿刺方法進(jìn)行隨機(jī)分組，第一種無負(fù)壓穿刺方法共1080個(gè)結(jié)節(jié)，第二種有負(fù)壓穿刺方法共1920個(gè)結(jié)節(jié)；并根據(jù)結(jié)節(jié)大小，分成三組（結(jié)節(jié)1cm組，0.5cm結(jié)節(jié)1cm組，結(jié)節(jié)0.5cm組），結(jié)節(jié)1cm組692個(gè)，0.5cm結(jié)節(jié)1cm組1038個(gè)，結(jié)節(jié)0.5cm組1270個(gè)。對照分析3000個(gè)甲狀腺結(jié)節(jié)細(xì)胞學(xué)及病理學(xué)結(jié)果，得出穿刺細(xì)胞學(xué)的準(zhǔn)確性、敏感性、特異性、假陽性率、假陰性率，比較二種穿刺方法的準(zhǔn)確性、敏感性、特異性、假陽性率、假陰性率。并比較根據(jù)結(jié)節(jié)大小分組的三組患者的準(zhǔn)確性、敏感性、特異性、假陽性率、假陰性率。采用SPSS13.0統(tǒng)計(jì)軟件分析數(shù)據(jù)，計(jì)數(shù)資料采用X2檢驗(yàn)，以P0.05差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果：通過病理學(xué)診斷3000個(gè)結(jié)節(jié)中良性病變1179個(gè)：結(jié)節(jié)性甲狀腺腫761個(gè)、甲狀腺腺瘤409個(gè)、甲狀腺炎209個(gè)。惡性病變1821個(gè)：甲狀腺乳頭狀癌1802個(gè)、髓樣癌11個(gè)、未分化癌4個(gè)、甲狀腺濾泡狀腺癌5個(gè)。細(xì)胞學(xué)穿刺成功2987個(gè)，13個(gè)因涂片不滿意取材不成功。甲狀腺結(jié)節(jié)良性病變1179個(gè)中，US-FNA診斷良性1061個(gè)、惡性14個(gè)、可疑惡性91個(gè)；涂片不滿意13個(gè)。甲狀腺結(jié)節(jié)惡性病變1821個(gè)中，US-FNA診斷惡性1421個(gè)、可疑惡性181個(gè)、良性219個(gè)。以病理學(xué)檢查結(jié)果作為金標(biāo)準(zhǔn)，分析甲狀腺結(jié)節(jié)細(xì)針穿刺細(xì)胞學(xué)檢查的結(jié)果，其準(zhǔn)確性、敏感性、特異性、假陽性率、假陰性率分別為88.77%、87.97%、89.99%、8.9%、12.03%。穿刺方式不同的二組中，無負(fù)壓穿刺組準(zhǔn)確性、敏感性、特異性、假陽性率、假陰性率分別為88.14%、88.41%、87.69%、11.06%、11.58%，有負(fù)壓穿刺組準(zhǔn)確性、敏感性、特異性、假陽性率、假陰性率分別為88.48%、87.18%、90.40%、8.58%、12.82%。經(jīng)各項(xiàng)比較P均0.05，統(tǒng)計(jì)學(xué)無差異。以甲狀腺結(jié)節(jié)大小分組的三組中，結(jié)節(jié)1cm組準(zhǔn)確性、敏感性、特異性、假陽性率、假陰性率分別為96.53%、96.18%、97.07%、2.93%、3.82%。0.5cm結(jié)節(jié)1cm組準(zhǔn)確性、敏感性、特異性、假陽性率、假陰性率分別為95.47%、95.54%、95.37%、3.90%、4.46%。結(jié)節(jié)0.5cm組準(zhǔn)確性、敏感性、特異性、假陽性率、假陰性率分別為83.31%、80.88%、87.10%、10.89%、19.12%。結(jié)節(jié)1cm組與0.5cm結(jié)節(jié)1cm組，二組準(zhǔn)確性、敏感性、特異性、假陽性率、假陰性率各項(xiàng)比較P均0.05，統(tǒng)計(jì)學(xué)無差異。0.5cm結(jié)節(jié)1cm組與結(jié)節(jié)0.5cm組，各項(xiàng)比較P均0.05，差異有統(tǒng)計(jì)學(xué)意義。3000個(gè)結(jié)節(jié)穿刺，有5個(gè)并發(fā)穿刺后出血，，無其它嚴(yán)重并發(fā)癥，其中實(shí)性2個(gè)，囊實(shí)性3個(gè)。局部按壓30分鐘后，再次行彩色多普勒超聲檢查，均未見明顯異常。 結(jié)論： （1）二種甲狀腺結(jié)節(jié)細(xì)針穿刺細(xì)胞學(xué)檢查的方法，其準(zhǔn)確性、敏感性、特異性、假陽性率、假陰性率經(jīng)比較，P均0.05，統(tǒng)計(jì)學(xué)無差異。 （2）甲狀腺結(jié)節(jié)細(xì)針穿刺細(xì)胞學(xué)檢查中，0.5cm結(jié)節(jié)1cm組與結(jié)節(jié)0.5cm組，二組準(zhǔn)確性、敏感性、特異性、假陰性率比較，P均0.05，差異有統(tǒng)計(jì)學(xué)意義。 （3）甲狀腺結(jié)節(jié)穿刺細(xì)胞學(xué)檢查對甲狀腺結(jié)節(jié)良、惡性的鑒別準(zhǔn)確性較高，為臨床提供可靠的影像學(xué)診斷。
[Abstract]:Objective: To study the clinical application value of two different puncture methods by the results of the fine needle aspiration cytology and the pathological results of the large sample size thyroid nodules. Malignant diagnostic value. Methods: From May, 2011 to February, 2014, there were 3000 thyroid nodules in 2574 patients with thyroid nodule fine needle biopsy in our hospital. Section. All the nodules are subject to a pathology or a biopsy of a surgical pathology. Real. In the course of the puncture of 3000 nodules, two kinds of puncture methods are used for randomization. The first non-negative pressure puncture method has 1080 nodules, and the second has a negative pressure puncture method for 1920 nodules, and according to the size of the nodules, it is divided into three groups (the node 1cm group, 0. 5cm nodule, 1cm). Group (group, nodule: 0. 5 cm), node 1cm group, 692, 0. 5cm, 1 cm group, 1038, and nodule 0. 5cm, group 1270. The accuracy, sensitivity, specificity, false positive rate and false negative rate of the puncture cytology were obtained by comparing the cytology and the pathological results of 3000 thyroid nodules. The accuracy, sensitivity, specificity, false positive rate and false negative of the two kinds of puncture methods were compared. and comparing the accuracy, sensitivity, specificity, false positive rate, false negative, The data were analyzed by SPSS 13.0. The data of the data were analyzed by X2. The difference of the data was P0. 05. Results: There were 1179 benign lesions in the 3000 nodules by pathology: the nodular goiter 761, the thyroid adenoma 409 and the thyroiditis 2. 09. malignant lesions (1821): papillary carcinoma (1802), medullary carcinoma (11), undifferentiated carcinoma (4), thyroid follicular gland 5 cases of cancer, 2987 for cytologic puncture and 13 for the non-satisfactory results of the smear. Not successful. Among the 1179 benign lesions of the thyroid nodules, the US-FNA was diagnosed as benign 1061, malignant in 14, and the suspicious malignant was 91; the smear was not satisfactory. 13. Among the 1821 cases of malignant lesions of thyroid nodules, US-FNA was diagnosed as malignant in 1421 cases, and the suspicious malignant was 181 and benign. The accuracy, sensitivity, specificity, false positive rate and false negative rate were 88. 77%, 87. 97%, 89. 99%, 8. 9%, 12. The accuracy, sensitivity, specificity, false positive rate and false negative rate were 88. 14%, 88. 41%, 87. 69%, 11. 06%, 11. 58%, respectively. The accuracy, sensitivity, specificity, false positive rate and false negative rate of negative pressure puncture group were 88. 48%, 87. 18%, 90. 40%, 8. 58%, 12. 82%. All P-0.05, statistics There was no difference. The accuracy, sensitivity, specificity, false positive rate and false negative rate of the group were 90.53%, 90.18%, 97.07%, 2.93%, 3.82%, 0.5cm, and the false negative rate were 90.47% and 95% respectively in the three groups of the thyroid nodule size group. 54%, 95. 37%, 3. 90%, 4. The accuracy, sensitivity, specificity, false positive rate and false negative rate were 83.31%, 80.88%, 87.0% and 10.89%, respectively. The accuracy, the sensitivity, the specificity, the false positive rate and the false negative rate of the group with the nodules of 1 cm and 1 cm in the group of 0. 5 cm, the positive rate of false negative and the false negative rate were all 0. 05, the difference was no difference. There were 5 concurrent post-puncture bleeding, no other serious complications, 2 of which were real, and the bladder was solid. 3. After the local press for 30 minutes, the color Doppler ultrasonic examination was performed again, none of which was found. explicit exception Conclusion: (1) The accuracy, sensitivity, specificity, false positive rate and false negative rate of two kinds of thyroid nodules are compared. (2) The accuracy, sensitivity, specificity and false-negative rate of the 0. 5cm nodules in the thyroid nodule were compared with that in the 0. 5 cm group. (3) The accuracy of the cytological examination of thyroid nodules is high and the accuracy of the differential diagnosis of thyroid nodules is high.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R581;R445.1

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