目的: 探讨在TI-RADS 4类甲状腺结节中应用超声引导下细针穿刺细胞学（fine needle aspiration biopsy, FNAB)检查的价值。方法: 回顾性分析甲状腺结节TI-RADS 4类病人217例共221个结节,行超声引导FNAB的资料。将其分为3组：TI-RADS 4A类、TI-RADS 4B类、TI-RADS 4C类。以术后病理诊断为金标准,采用Kappa一致性检验方法评价超声引导FNAB与术后病理结果的一致性。计算超声引导下FNAB的特异度、灵敏度、阴性预测值、阳性预测值,以术后病理结果为标准。结果: 3组病变Kappa值分别为0.86（TI-RADS 4A类）、0.77（TI-RADS 4B类）、0.82（TI-RADS 4C类）,均>0.75。超声引导FNAB的特异度、灵敏度、阴性预测值、阳性预测值TI-RADS 4A类组分别为98.1%、77.8%、96.2%、88.0%,4B类组分别为90.6%、86.0%、88.9%、88.1%,4C类组分别为83.3%、98.3%、83.3%、98.3%。超声引导FNAB与术后病理结果具有较高的一致性（P<0.01）。结论: 超声引导FNAB联合TI-RADS分类可提高TI-RADS 4类甲状腺结节的诊断准确率。
Objective To study the value of ultrasound-guided fine needle aspiration biopsy (FNAB) in diagnosing TI-RADS 4 thyroid nodules. Methods A retrospective analysis was conducted on the data of 217 patients with 221 thyroid nodules of TI-RADS 4 by ultrasound-guided FNAB. The cases were divided into TI-RADS 4A group, TI-RADS 4B group and TI-RADS 4C group. Postoperative pathological results were taken as gold standard and Kappa consistency test was used to evaluate the consistency of ultrasound-guided FNAB with postoperative pathological results. The specificity, sensitivity, negative and positive predictive values of ultrasound-guided FNAB were gotten based on postoperative pathological results as standard. Results The Kappa values were 0.86 of TI-RADS 4A group, 0.77 of TI-RADS 4B group and 0.82 of TI-RADS 4C group, respectively. All values were more than 0.75. Specificity, sensitivity, negative and positive predictive values of ultrasound-guided FNAB were 98.1%, 77.8%, 96.2%, 88.0% in TI-RADS 4A group; 90.6%, 86.0%, 88.9%,88.1% in TI-RADS 4B group; and 83.3%, 98.3%, 83.3%, 98.3% in TI-RADS 4C group. Higher consistence was seen between with postoperative pathological results and ultrasound-guided FNAB results (P<0.01). Conclusions Combination of TI-RADS classification and ultrasound-guided FNAB can increase the accuracy of ultrasound diagnosis of TI-RADS 4 thyroid nodules.
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