10 388个甲状腺结节行超声引导下细针抽吸活检的甲状腺癌各亚型诊断准确率的10年研究

doi:10.16150/j.1671-2870.2020.04.007

摘要/Abstract

摘要：

目的： 探讨超声引导下细针抽吸活检（ultrasound-guided fine needle aspiration biospy,US-FNAB）对甲状腺恶性病变中亚型的诊断准确率。方法： 回顾性分析2010年1月至2019年12月间9 933例在上海交通大学医学院附属瑞金医院接受US-FNAB 者的相关资料,共10 388个甲状腺结节,以术后病理为金标准,评价US-FNAB诊断甲状腺癌的灵敏度、特异度、准确率、阳性预测值、阴性预测值等,并进一步分析其在恶性病变中各亚型的诊断准确率。结果： 总结10年间的US-FNAB结果数据发现,10 388个结节中有9 379个（90.3%）为恶性,总诊断灵敏度为95.4%,总特异度为84.7%,总阳性预测值98.4%,总阴性预测值为65.9%,总诊断准确率达94.4%;对于各恶性病变亚型,乳头状癌的诊断准确率为95.8%,髓样癌的诊断准确率为69.4%。结论： US-FNAB在恶性甲状腺结节诊断中具有较高的价值,其对甲状腺乳头状癌的诊断效能最高。

关键词: 甲状腺癌, 超声引导下细针抽吸活检甲状腺乳头状癌

Abstract:

Objective: To investigate the diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy (US-FNAB) in different subtypes of thyroid carcinoma. Methods: A total of 10 388 thyroid nodules from 9 933 patients undergone US-FNAB in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2010 to December 2019 were enrolled, and related data were retrospectively analyzed. The sensitivity, specificity, accuracy, positive and negative predictive value of US-FNAB for thyroid carcinoma were assessed by comparing to the results of surgical pathology. The accuracy rate of diagnosis between different subtypes of thyroid carcinoma was further analyzed. Results: The ten-year study revealed that among 10 388 nodules, 9 379 nodules were malignant. The total sensitivity, specificity, positive and negative predictive value of US-FNAB for thyroid carcinoma were 95.4%, 84.7%, 98.4%, 65.9% and 94.4%, respectively. For the subtypes of thyroid carcinoma, diagnostic accuracies for papillary carcinoma and medullary carcinoma were 95.8% and 69.4%, respectively. Conclusions: US-FNAB is valuable in the diagnosis of thyroid nodules and has the highest diagnostic accuracy for thyroid papillary carcinoma.

Key words: Thyroid carcinoma, Ultrasound-guided fine needle aspiration biopsy, Papillary carcinoma of thyroid

中图分类号:

R736.1

王星, 汪蓉晖, 张桂萍, 董屹婕, 周伟, 詹维伟. 10 388个甲状腺结节行超声引导下细针抽吸活检的甲状腺癌各亚型诊断准确率的10年研究[J]. 诊断学理论与实践, 2020, 19(04): 359-363.

WANG Xing, WANG Ronghui, ZHANG Guiping, DONG Yijie, ZHOU Wei, ZHAN Weiwei. Diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy for different thyroid carcinoma in 10 388 thyroid nodules: a ten-year study[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(04): 359-363.

图/表 2

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指标	2010年至2014年	2015年	2016年	2017年	2018年	2019年	总计
灵敏度（%）	95.1	97.4	96.8	95.1	94.8	94.7	95.4
特异度（%）	71.0	81.3	77.8	90.4	88.6	92.1	84.7
阳性预测值（%）	96.8	98.0	98.0	98.8	98.8	99.1	98.4
阴性预测值（%）	61.2	77.0	67.9	68.5	62.6	64.5	65.9
阳性似然比（+）	3.279	5.209	4.355	9.860	8.349	12.015	6.220
阴性似然比（-）	0.069	0.032	0.041	0.054	0.059	0.058	0.054
准确率（%）	92.8	95.8	95.3	94.6	94.2	94.5	94.4
约登指数	0.661	0.787	0.746	0.855	0.834	0.868	0.801

病理类型	2010年至2014	2015年	2016年	2017年	2018年	2019年	总计
乳头状癌（%）	95.4(1 418/1 487)	97.7(952/974)	97.2(1 276/1 313)	95.3(1 577/1 654)	95.2(1 751/1 839)	95.0(1 810/1 906)	95.8(8 784/9 173)
髓样癌（%）	5/7	9/13	8/13	7/10	65.5(19/29)	76.9(20/26)	69.4(68/98)