目的:探讨颈部淋巴结细针穿刺病理(fine needle aspiration cytodiagnosis, FNAC)联合检测穿刺针洗脱液甲状腺球蛋白(Thyroglobulin measurement in fine-needle aspiration biopsy, FNA-Tg)检测对老年甲状腺乳头状癌(PTC)颈淋巴结转移患者的应用价值。方法:回顾性分析2021年3月至2021年11月齐齐哈尔市第一医院甲状腺外科疑似为甲状腺乳头状癌颈淋巴结转移老年病人40例的临床资料,所以患者均接受FNAC病理学检查及FNA-Tg检测,以术后病理结果作为金标准,比较单独FNAC与两者联合检测的诊断诊断价值。结果:两者联合检测的敏感性、阴性预测值、准确率为均显著高单独FNAC (P < 0.05),有统计学意义。结论:应用FNAC联合FNA-Tg检测技术是一种简便易行的诊断方法,在诊断甲状腺乳头状癌淋巴结转移具有较高的诊断效能,值得临床推广应用。 Objective: To investigate the value of fine needle aspiration biopsy (FNAC) combined with thy-roglobulin (FNA-Tg) detection in needle elution in cervical lymph node metastasis of elderly pa-tients with papillary thyroid carcinoma (PTC). Methods: The clinical data of 40 elderly patients sus-pected of cervical lymph node metastasis of papillary thyroid cancer in the thyroid surgery de-partment of the First Hospital of Qiqihar City from March 2021 to November 2021 were analyzed retrospectively. All patients received FNAC pathological examination and FNA-Tg detection. With the postoperative pathological results as the gold standard, the diagnostic value of FNAC alone and their combined detection was compared. Results: The sensitivity, negative predictive value and ac-curacy rate of the combined detection were significantly higher than those of FNAC alone (P < 0.05). Conclusion: FNAC combined with FNA-Tg detection technology is a simple and easy diagnostic method, which has high diagnostic efficacy in the diagnosis of lymph node metastasis of thyroid pa-pillary carcinoma, and is worthy of clinical application.
目的:探讨颈部淋巴结细针穿刺病理(fine needle aspiration cytodiagnosis, FNAC)联合检测穿刺针洗脱液甲状腺球蛋白(Thyroglobulin measurement in fine-needle aspiration biopsy, FNA-Tg)检测对老年甲状腺乳头状癌(PTC)颈淋巴结转移患者的应用价值。方法:回顾性分析2021年3月至2021年11月齐齐哈尔市第一医院甲状腺外科疑似为甲状腺乳头状癌颈淋巴结转移老年病人40例的临床资料,所以患者均接受FNAC病理学检查及FNA-Tg检测,以术后病理结果作为金标准,比较单独FNAC与两者联合检测的诊断诊断价值。结果:两者联合检测的敏感性、阴性预测值、准确率为均显著高单独FNAC (P < 0.05),有统计学意义。结论:应用FNAC联合FNA-Tg检测技术是一种简便易行的诊断方法,在诊断甲状腺乳头状癌淋巴结转移具有较高的诊断效能,值得临床推广应用。
老年,细针穿刺细胞学检查,穿刺针洗脱液甲状腺球蛋白,甲状腺乳头状癌颈淋巴结转移
Xiaoxue Liu, Ning Xu, Weiye Fan*
Qiqihar First Hospital and Qiqihar Hospital Affiliated to Southern Medical University, Qiqihar Heilongjiang
Received: Sep. 24th, 2022; accepted: Oct. 17th, 2022; published: Oct. 27th, 2022
Objective: To investigate the value of fine needle aspiration biopsy (FNAC) combined with thyroglobulin (FNA-Tg) detection in needle elution in cervical lymph node metastasis of elderly patients with papillary thyroid carcinoma (PTC). Methods: The clinical data of 40 elderly patients suspected of cervical lymph node metastasis of papillary thyroid cancer in the thyroid surgery department of the First Hospital of Qiqihar City from March 2021 to November 2021 were analyzed retrospectively. All patients received FNAC pathological examination and FNA-Tg detection. With the postoperative pathological results as the gold standard, the diagnostic value of FNAC alone and their combined detection was compared. Results: The sensitivity, negative predictive value and accuracy rate of the combined detection were significantly higher than those of FNAC alone (P < 0.05). Conclusion: FNAC combined with FNA-Tg detection technology is a simple and easy diagnostic method, which has high diagnostic efficacy in the diagnosis of lymph node metastasis of thyroid papillary carcinoma, and is worthy of clinical application.
Keywords:The Elderly, Fine Needle Aspiration Cytodiagnosis, Thyroglobulin Measurement in Fine-Needle Aspiration Biopsy, Thyroid Papillary Carcinoma Was Transferred
Copyright © 2022 by author(s) and Hans Publishers Inc.
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甲状腺癌为目前的常见病、多发病,在我国的发病率仍在逐年上升,其中甲状腺乳头状癌(Papillary Thyroid Carcinoma, PTC)最为常见,且早期可发生中央区淋巴转移,20%~90% PTC病人在确诊时已存在颈淋巴转移 [
收集2020年3月至2020年11月间,在甲状腺外科就诊,经超声诊断为甲状腺癌且可疑有颈部淋巴结转移的老年病患,约38例。诊断标准:参照《中国临床肿瘤学会(CSCO)分化型甲状腺癌诊疗指南2021》 [
患者仰卧位,常规消毒、铺无菌巾,1%利多卡因局部麻醉;在采用GELogiqE9型超声仪引导下、采用22G活检针穿刺病灶(以可疑淋巴结边缘实性部分为重点穿剌处),快速抽插,见针尾部有血性液体引出即可;穿刺液依据细胞学诊断进行常规涂片及固定,然后进行染色及观察送病理科进行细胞学病理检查。FNA-Tg洗脱液:1 mL针筒吸取1 mL 0.9%氯化钠注射液,将穿刺针反复抽吸推出冲洗后,洗脱液送检。用化学发光免疫分析法检测Tg浓度。
结果的判定:1) 涂片细胞学检查:经副主任医师以上级别病理科医师阅片进行诊断。将细胞病理学检查发现恶性肿瘤细胞定为淋巴结转移阳性,而未见恶性肿瘤细胞定为淋巴结转移阴性。所穿剌淋巴结均做在超声定位。FNA-Tg以2.0 ng/ml作为截断值。
以术后病理结果为金标准,计算并比较FNA-Tg、FNAC与FNA-Tg联合FNAC诊断的敏感率、特异率、准确率、阳性预测值和阴性预测值。其中:特异率 = 真阴性/(真阴性 + 假阳性) × 100%;敏感率 = 真阳性/(真阳性 + 假阴性) × 100%,准确率 = (真阳 + 真阴)/总例数 × 100%;阴性预测值 = 真阴性/(真阴 + 假阳性) × 100%,阳性预测值 = 真阳性/(真阳性 + 假阴性) × 100%。FNAC或联合法记为阳性者而术后石蜡病理未定转移癌者为假阳性,FNA-Tg、FNAC或联合法记为阴性者而术后石蜡病理未定转移癌者为假阴性,观察并记录种方法淋巴结阳性数目、阴性数目。比较单独使用FNA-Tg、FNAC与联合法(FNAC联合FNA-Tg)诊断PTC颈部淋巴结转移的敏感性、特异性及准确率。
所有统计数据代入spss20.0统计软件包,进行统计分析,计数资料以[n(%)]表示,行χ2检验,P < 0.05有统计学意义。
两种方法病例穿剌结果如下,38例患者中,选取可疑为转移癌淋巴结共计38枚,术后病理诊断显
穿剌结果 | 病理结果 | |||
---|---|---|---|---|
阴性 | 阳性 | 阴性 | 阳性 | |
FNAC | 17 | 21 | 7 | 31 |
FNA-Tg | 13 | 25 | ||
联合法 | 10 | 28 | ||
合计 | 10 | 74 | 7 | 31 |
表1. 不同检查方法颈部转移性淋巴结接触结果38例
示,其中良性淋巴结7枚(%);为转移癌者淋巴结为31枚(%)。单独FNA-Tg和FNAC检测淋巴结转移癌者明显低于FNA-Tg联合FNAC法(P < 0.05),见表1。
两种检测方法比较,病例敏感性、准确率及阴性预测值比较可见联合法均显著高于单独FNAC及FNA-Tg法,特异性及阳性预测值两者相同。具体见表2。
方法 | 敏感性 | 特异性 | 阳性预测值 | 阴性预测值 | 准确率 |
---|---|---|---|---|---|
联合法 | 96.15 | 100 | 100 | 90 | 96.67 |
FNAC | 76 | 100 | 100 | 45.45 | 80 |
FNA-Tg | 85 | 99.21 | 100 | 75.21 | 92.4 |
x2值 | 21.009 | 1.072 | 1.274 | 13.047 | 19.294 |
P | 值 | 0.000 | 0.298 | 0.261 | 0.000 |
表2. 两组病例敏感性、特异性阳性预测值、阴性预测值及准确率的比较(%)
甲状腺乳头状癌为目前常见肿瘤,早期可出现侧颈区淋巴转移。彩超是检测颈部淋巴结的首要也是重要方法,老年病人身体条件差,手术更应慎重,故术前明确诊断尤为重要。细针穿刺细胞学检查,对于淋巴结转移癌的诊断率高,其诊断特异性也高,但是其敏感度及准确率并不理想,有一定的假阴性率 [
本研究中联合法的敏感性、准确率及阴性预测值均显著高单独FNA-Tg和FNAC,与其他学者研究结论相当,可见在老年甲状腺癌患者中联合法的诊断效能仍优于单独FNA-Tg和FNAC。FNAC与FNA-Tg于老年甲状腺乳头状癌颈部转移性淋巴结诊断效能比较差异无统计学意义(P > 0.05),说明在此研究范围内,两者的诊断效能相当。
本研究中FNAC与FNA-Tg单独的诊断的敏感性偏低,考虑为1) 样本数量少,则阳性样本量相对较少,今后应延长研究时间及扩大样本量,期望可减少上述偏倚;2) 缺乏对FNA-Tg截点的研究分析。
综上,FNAC联合FNA-Tg检测对老年甲状腺乳头状癌术前评估及术后复查效果满意,诊断效能高。适于在老年甲状腺乳头状癌患者围手术期中推广应用。
刘晓雪,徐 宁,樊伟业. FNAC联合FNA-Tg在老年甲状腺乳头状癌颈部淋巴结转移诊断中的应用研究FNAC Combined with FNA-Tg in Elderly Papillary Thyroid Carcinoma Applied Study on the Diagnosis of Cervical Lymph Node Metastasis[J]. 临床医学进展, 2022, 12(10): 9670-9674. https://doi.org/10.12677/ACM.2022.12101397