上海交通大学学报（医学版）

›› 2010, Vol. 30 ›› Issue (11): 1397-.doi: 10.3969/j.issn.1674-8115.2010.11.019

• 论著（临床研究） • 上一篇    下一篇

28例甲状腺癌的细针穿刺细胞学诊断及超声影像学特征分析

周季兰1, 邢晋放2, 金宇飚3, 杜联芳2, 陈嘉薇3   

  1. 1.上海交通大学 医学院附属新华医院急救中心, 上海 200433； 2.上海交通大学附属第一人民医院超声科, 上海 200080； 3.上海交通大学附属第一人民医院病理科, 上海 200080
  • 出版日期:2010-11-25 发布日期:2010-11-29
  • 作者简介:周季兰（1977—）, 女, 主治医师, 硕士；电子信箱: lanlan204099@yahoo.com.cn。

Clinical and pathological analysis in 28 cases of thyroid cancer diagnosed by fine needle aspiration biopsy

ZHOU Ji-lan1, XING Jin-fang2, JIN Yu-biao3, DU Lian-fang2, CHEN Jia-wei3   

  1. 1.Department of Emergency Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200433, China；2.Department of Ultrasound, 3.Department of Pathology, The First People's Hospital, Shanghai Jiaotong University, Shanghai 200080, China
  • Online:2010-11-25 Published:2010-11-29

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摘要：

目的 分析经穿刺细胞学诊断甲状腺癌肿瘤组织的病理学特征及超声影像学表现，提高甲状腺结节穿刺的诊断准确率。方法 收集28例在超声引导下经细针穿刺细胞学诊断为甲状腺癌患者的相关资料，回顾穿刺细胞学诊断情况，并与术后组织病理学检查结果进行比较，结合结节超声图像表现特点加以分析。结果 穿刺细胞学检查诊断的28例甲状腺癌中，乳头状癌26例，髓样癌2例；所有乳头状癌结节样本中，细胞核均可见特征性核沟及核内假包涵体。细胞学检查结果均经术后组织病理学检查证实，其中癌结节≥2 cm者13例，＜2 cm癌结节者15例；单发结节15例，多发结节13例；23例（82.14%）结节边缘向四周浸润破坏性生长，并伴有周围纤维组织反应性增生；22例（78.57%）结节中可见钙化灶，其中16例（72.73%）表现为沙砾样钙化。超声图像分析显示，多数结节内可见沙砾样钙化灶，结节边缘欠规则呈粗糙毛刺状。结论 超声定位有助于提高触诊难及小结节的穿刺成功率；综合分析超声图像中甲状腺结节边缘及钙化的特征性表现，可有效提高穿刺细胞学检查的阳性诊断准确率。

关键词: 甲状腺, 结节, 超声定位, 细针穿刺, 微小钙化

Abstract:

Objective To improve the diagnosis rate of fine needle aspiration biopsy in thyroid malignant tumors through comparing the features between cytopathology and histopathology, together with the characters of ultrasound images. Methods The data of 28 cases of thyroid cancer diagnosed by fine needle aspiration biopsy were collected, and the cytological and histological features were reviewed. The ultrasound images of the cases were also analyzed. Results Twenty-six cases of papillary carcinoma and 2 cases of medullary carcinoma diagnosed by fine needle aspiration biopsy were confirmed by histological diagnosis afterward. In all the node samples of papillary carcinoma, characteristic nuclear grooves and pseudo-inclusion bodies were found in nuclei. Of the 28 cases of thyroid cancer, the diameters of nodes were ≥2 cm in 13 cases and ＜2 cm in 15 cases. Fifteen cases had a single node while 13 cases had multiple nodes. Twenty-two cases （78.57%）had calcification in nodes, 16 （72.73%）of which were microminiature. Twenty-three cases （82.14%）showed irregular edges that were histologically confirmed as the performance of the infiltrative growth of the tumor and the reaction of the mesenchyme. Ultrasound image analysis revealed that most nodes had gravel-like calcification, with irregular and spiculated edges. Conclusion Fine needle aspiration biopsy under ultrasound guiding could improve the accuracy in finding micro nodes. The analysis of characters of edge and calcification in thyroid nodes on ultrasound images could increase the diagnosis rate of fine needle aspiration biopsy.

Key words: thyroid, node, ultrasound localization, fine needle aspiration biopsy, microcalcification