目的: 探讨超声引导下甲状腺细针穿刺活检（ultrasound-guided fine-needle aspiration biopsy, US-FNAB）细胞学检查与超声甲状腺影像报告和数据系统（thyroid imaging reporting and data system, TI-RADS）分级联合应用在甲状腺结节诊断中的价值,以期更好地对甲状腺结节进行术前定性诊断。方法: 回顾性分析2017年1月至2017年6月于上海交通大学医学院附属瑞金医院进行甲状腺超声引导下细针穿刺的2 901例患者,将其细胞学涂片检查诊断结果与超声TI-RADS分级进行对照分析。结果: 通过与细胞学诊断结果对照发现,TI-RADS 3、4A类结节中,甲状腺良性结节的构成比分别为94.00%、61.62%,TI-RADS 4A、4B、4C、5类结节中,恶性结节的构成比分别为38.38%、78.34%、87.02%、92.87%。经超声TI-RADS分级诊断为恶性的甲状腺结节（TI-RADS 4B、4C、5类）共915个,而其中经US-FNAB细胞学涂片病理检查结果证实为恶性的结节有745例,符合率为81.42%;其中,700例细胞学诊断为恶性结节的患者进行了手术,与术后病理诊断间的吻合率为99.5%。结论: 建议对于超声TI-RADS分级结果中4A及以上分级的患者,需行US-FNAB以明确结节性质;US-FNAB 与TI-RADS分级联合应用可较好地鉴别诊断甲状腺结节,对术前定性诊断有重要临床意义。
Objective: To study the value of ultrasound-guided fine-needle aspiration biopsy(US-FNAB) and thyroid ultrasound imaging reporting and data system(TI-RADS) in the diagnosis of thyroid nodules. Methods: Data from 2 901 patients undergone thyroid ultrasound guided fine needle aspiration biopsy at Ruijin Hospital during January 2017 to June 2017 were retrospectively reviewed, and the cytologic findings were contrasted with the results of TI-RADS classification. Results: According to the results of cytological diagnosis, thyroid benign nodules were more commonly seen in TI-RADS 3 and 4A and accounting for 94.00% and 61.62%, respectively; while malignant nodules were commonly seen in TI-RADS 4A, 4B, 4C, and 5 and accounting for 38.38%, 78.34%, 87.02% and 92.87%, respectively. Conclusions: It is recommended that when one or more of the indicators in ultrasound TI-RADS classification suggests a malignant nodule(≥4A), US-FNAB is required to identify the character of the nodule. US-FNAB combined with TI-RADS classification can be used in the differential diagnosis of thyroid nodules and has importantclinical significance for preoperative diagnosis.
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