现场快速评估法辅助超声引导下甲状腺细针穿刺的研究

doi:10.3969/j.issn.1674-8115.2023.08.011

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (8): 1032-1037.doi: 10.3969/j.issn.1674-8115.2023.08.011

• 论著 · 临床研究 • 上一篇

现场快速评估法辅助超声引导下甲状腺细针穿刺的研究

贺玉洁¹(), 樊琳蕊², 张翘楚¹, 张至立¹, 丁珺¹, 施超³, 姚勇强¹, 任宏政¹()

^1.上海市浦东新区公利医院病理科，上海 200135
^2.上海市浦东新区公利医院防保科，上海 200135
^3.上海市浦东新区公利医院内分泌科，上海 200135

收稿日期:2023-06-19 接受日期:2023-07-17 出版日期:2023-08-25 发布日期:2023-08-25
通讯作者: 任宏政 E-mail:13636566182@163.com;13683789899@163.com
作者简介:贺玉洁（1972—），女，主管技师，本科；电子信箱: 13636566182@163.com。
基金资助:
上海市浦东新区卫生系统重要薄弱学科建设项目(PWZbr2022-18);2022年浦东新区卫健委重点专科建设项目(PWZzk2022-05)

Study on ultrasound-guided thyroid fine needle puncture assisted by rapid on-side evaluation

HE Yujie¹(), FAN Linrui², ZHANG Qiaochu¹, ZHANG Zhili¹, DING Jun¹, SHI Chao³, YAO Yongqiang¹, REN Hongzheng¹()

^1.Department of Pathology, Gongli Hospital of Shanghai Pudong New Area, Shanghai 200135, China
^2.Department of Preventive Care, Gongli Hospital of Shanghai Pudong New Area, Shanghai 200135, China
^3.Department of Endocrinology, Gongli Hospital of Shanghai Pudong New Area, Shanghai 200135, China

Received:2023-06-19 Accepted:2023-07-17 Online:2023-08-25 Published:2023-08-25
Contact: REN Hongzheng E-mail:13636566182@163.com;13683789899@163.com
Supported by:
Shanghai Pudong New Area Health System Key Weak Discipline Construction Project(PWZbr2022-18);Key Specialty Construction Project of Pudong New Area Health Commission in 2022(PWZzk2022-05)

摘要/Abstract

摘要：

目的·探索现场快速评估法（rapid on-side evaluation，ROSE）辅助超声引导下甲状腺细针穿刺（ultrasound-guided fine needle aspiration cytology，US-FNAC）的临床效果。方法·回顾性分析2019年1月—2022年12月于上海市浦东新区公利医院确诊的甲状腺结节患者资料（n=874）。根据细胞学检测方法分为ROSE+液基薄层细胞学检测（thinprep cytologic test，TCT）组（n=469）和现场细胞涂片（cell smear，CS）+TCT组（n=405）。ROSE+TCT组中，ROSE的组织细胞采样采用迪夫快速染色检测，穿刺直至标本满意；CS+TCT组采用苏木精-伊红染色（hematoxylin-eosin staining，H-E染色）+巴氏液基细胞学染色检测。根据Bethesda报告系统（The Bethesda System for Reporting Thyroid Cytopathology，TBSRTC）细胞学分类标准进行细胞学诊断，比较2种方法的样本细胞不满意度和临床效果。结果·ROSE+TCT组与CS+TCT组的标本不满意度分别为2.4%和14.1%，差异具有统计学意义（P=0.000）。ROSE+TCT组的涂片细胞集中、结构清楚、易于观察。将ROSE+TCT组细胞学诊断结果为Ⅲ级及以上的样本制作为细胞蜡块，以提高后续诊断效率。CS+TCT组细胞涂片因细胞数少未能制作为细胞蜡块。ROSE+TCT组的穿刺次数与CS+TCT组的差异有统计学意义（P=0.011）。结论·现场快速评估法辅助超声引导下甲状腺细针穿刺可现场评估标本的有效细胞数量，现场反馈穿刺医师，可满足病理医师实现准确诊断的细胞采集数量要求，减少穿刺次数和治疗时间，为临床医师的诊断和后续检查起到较好的辅助作用。

关键词: 甲状腺结节, 现场快速评估法, 超声引导, 细针穿刺, 细胞量

Abstract:

Objective ·To explore the clinical effect of ultrasound-guided fine needle aspiration cytology assisted by rapid on-side evaluation (ROSE). Methods ·The data of patients with thyroid nodules diagnosed in Gongli Hospital of Shanghai Pudong New Area from January 2019 to December 2022 were retrospectively analyzed (n=874). According to cytological detection methods, they were divided into ROSE+thinprep cytologic test (TCT) group (n=469) and cell smear (CS)+TCT group (n=405). In the ROSE+TCT group, the tissue and cell samples of ROSE were detected by Diff-Quik staining and continue puncturing until the specimen was satisfied. In the CS+TCT group, the tissue and cell samples were detected by hematoxylin-eosin staining (H-E staining) + Pap staining. Cytologic diagnosis was made according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) cytologic classification criteria, and the cell dissatisfaction rates and clinical outcomes of the 2 methods were compared. Results ·The dissatisfaction rates of the ROSE+TCT group and CS+TCT group were 2.4% and 14.1%, respectively, with statistical significance (P=0.000). The smear cells of the ROSE+TCT group were concentrated, and the structure was clear and easy to observe. The samples with a cytologic diagnosis of grade Ⅲ and above were prepared as cell wax blocks to improve the efficiency of subsequent diagnosis. The cells of the CS+TCT group could not produce wax blocks due to the small numbers of cells. The puncture times of the ROSE+TCT group were significantly different from that of the CS+TCT group (P=0.011). Conclusion ·The ultrasound-guided thyroid fine needle aspiration assisted by rapid on-site assessment method can assess the effective number of cells in the specimen on the spot, give feedback to the puncturing doctors on the spot, meet the diagnostic accuracy requirements of pathologists by collecting a sufficient number of cells, reduce the number of punctures and treatment time, and play a good auxiliary role in the diagnosis and follow-up examination of clinicians.

Key words: thyroid nodule, rapid on-side evaluation (ROSE), ultrasonic guidance, fine needle aspiration, cell mass

中图分类号:

R581.3

贺玉洁, 樊琳蕊, 张翘楚, 张至立, 丁珺, 施超, 姚勇强, 任宏政. 现场快速评估法辅助超声引导下甲状腺细针穿刺的研究[J]. 上海交通大学学报（医学版）, 2023, 43(8): 1032-1037.

HE Yujie, FAN Linrui, ZHANG Qiaochu, ZHANG Zhili, DING Jun, SHI Chao, YAO Yongqiang, REN Hongzheng. Study on ultrasound-guided thyroid fine needle puncture assisted by rapid on-side evaluation[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(8): 1032-1037.

图/表 4

参考文献 20

1	中华医学会老年医学分会老年内分泌代谢疾病学组, 中华医学会内分泌学分会甲状腺学组. 中国老年人甲状腺疾病诊疗专家共识(2021)[J]. 中华内分泌代谢杂志, 2021, 37(5): 399-418.
	Endocrine Metabolic Diseases Group of the Chinese Geriatrics Society, Thyroid Group of the Chinese Society of Endocrinology, Chinese Medical Association. Expert consensus on diagnosis and treatment for elderly with thyroid diseases in China (2021)[J]. Chinese Journal of Endocrinology and Metabolism, 2021, 37(5): 399-418.
2	WOUTERS H J C M, SLAGTER S N, MULLER KOBOLD A C, et al. Epidemiology of thyroid disorders in the Lifelines Cohort Study (the Netherlands)[J]. PLoS One, 2020, 15(11): e0242795.
3	ALEXANDER E K, CIBAS E S. Diagnosis of thyroid nodules[J]. Lancet Diabetes Endocrinol, 2022, 10(7): 533-539.
4	于潇. 超声造影、MSCT及细针穿刺在甲状腺结节良恶性病变诊断中的应用[J]. 中国CT和MRI杂志, 2018, 16(8): 37-39.
	YU X. Application of contrast-enhanced ultrasonography, MSCT and fine needle aspiration cytology in the diagnosis of benign and malignant thyroid nodules[J]. Chinese Journal of CT and MRI, 2018, 16(8): 37-39.
5	吴俐俐, 刘振华, 程琳, 等. 超声引导下细针穿刺不同直径甲状腺结节诊断的临床应用价值[J]. 医学影像学杂志, 2023, 33(2): 336-339.
	WU L L, LIU Z H, CHENG L, et al. Clinical application of cytological diagnostic accuracy of thyroid nodules with different diameters by ultrasound-guided fine needle aspiration[J]. Journal of Medical Imaging, 2023, 33(2): 336-339.
6	赵瑞娜, 张青, 姜玉新, 等. 超声引导下细针穿刺在甲状腺结节诊疗中的应用进展[J]. 中华医学超声杂志(电子版), 2021, 18(9): 886-890.
	ZHAO R N, ZHANG Q, JIANG Y X, et al. Application of ultrasound-guided fine-needle aspiration in diagnosis and treatment of thyroid nodules[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(9): 886-890.
7	李苗, 冯凡, 连俊. 超声弹性成像色彩评分系统、二维超声及能谱CT对甲状腺良恶性结节诊断鉴别价值比较[J]. 中国CT和MRI杂志, 2021, 19(12): 24-26, 56.
	LI M, FENG F, LIAN J. Comparison of diagnostic value of ultrasound elastography color scoring system, two-dimensional ultrasound, and energy spectrum CT on benign and malignant thyroid nodules[J]. Chinese Journal of CT and MRI, 2021, 19(12): 24-26, 56.
8	KOBALY K, KIM C S, MANDEL S J. Contemporary management of thyroid nodules[J]. Annu Rev Med, 2022, 73: 517-528.
9	中华医学会内分泌学分会, 中华医学会外科学分会, 中国抗癌协会头颈肿瘤专业委员会, 中华医学会核医学分会. 甲状腺结节和分化型甲状腺癌诊治指南[J]. 中国肿瘤临床, 2012, 39(17): 1249-1272.
	Chinese Medical Association of Endocrinology, Chinese Medical Association of Surgery, Head and Neck Tumor Committee of Chinese Anti-Cancer Association, Chinese Medical Association of Nuclear Medicine. Guidelines for the diagnosis and treatment of thyroid nodules and differentiated thyroid cancer[J]. Chinese Journal of Clinical Oncology, 2012, 39(17): 1249-1272.
10	HAUGEN B R, ALEXANDER E K, BIBLE K C, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer[J]. Thyroid, 2016, 26(1): 1-133.
11	BERNET V J, CHINDRIS A M. Update on the evaluation of thyroid nodules[J]. J Nucl Med, 2021, 62(Suppl 2): 13S-19S.
12	黄万泽, 张哲嘉, 白宁, 等. 超声引导下细针穿刺对甲状腺结节的诊断价值及其影响因素[J]. 中国普通外科杂志, 2019, 28(11): 1347-1353.
	HUANG W Z, ZHANG Z J, BAI N, et al. Diagnostic value of ultrasound-guided fine needle aspiration for thyroid nodules and the influential factors[J]. China Journal of General Surgery, 2019, 28(11): 1347-1353.
13	汪旭, 李超, 何天琪, 等. 细胞学性质不确定甲状腺结节分子检测进展[J]. 国际耳鼻咽喉头颈外科杂志, 2020, 44(1): 20-24.
	WANG X, LI C, HE T Q, et al. Research progress in molecular detection of thyroid nodules with cytologically indeterminate thyroid nodules[J]. International Journal of Otolaryngology-Head and Neck Surgery, 2020, 44(1): 20-24.
14	樊金芳, 陶玲玲, 王怡, 等. 可疑甲状腺结节超声造影和细针穿刺的临床价值探讨[J]. 中国医学计算机成像杂志, 2017, 23(2): 179-184.
	FAN J F, TAO L L, WANG Y, et al. Clinical value of ultrasonography and fine needle aspiration in the diagnosis of suspicious thyroid nodules[J]. Chinese Computed Medical Imaging, 2017, 23(2): 179-184.
15	白甲顺. 超声引导细针穿刺活检技术对TI-RADS4类甲状腺结节良恶性鉴别诊断效能的影响[J]. 中国药物与临床, 2020, 20(2): 201-202.
	BAI J S. The effect of ultrasound-guided fine needle aspiration biopsy on the differential diagnosis of benign and malignant TI-RADS4 thyroid nodules[J]. Chinese Remedies and Clinics, 2020, 20(2): 201-202.
16	王星, 汪蓉晖, 张桂萍, 等. 10388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(4): 359-363.
	WANG X, WANG R H, ZHANG G P, et al. Diagnostic accuracy of ultrasound-guided fine needle aspiration biopsy for different thyroid carcinoma in 10388 thyroid nodules: a ten-year study[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(4): 359-363.
17	姚岚, 吴琼. TI-RADS联合超声弹性成像检查对甲状腺结节良恶性的鉴别诊断价值研究[J]. 中国实用医药, 2023, 18(4): 97-99.
	YAO L, WU Q. Study on the value of combined examination of TI-RADS and ultrasound elastography in differential diagnosis of benign and malignant thyroid nodules[J]. China Practical Medicine, 2023, 18(4): 97-99.
18	陈超, 陈大祥, 徐丹, 等. 高频彩超引导下改良法细针负压抽吸活检与无负压活检用于甲状腺结节的诊断价值比较[J]. 徐州医科大学学报, 2019, 39(6): 454-457.
	CHEN C, CHEN D X, XU D, et al. Comparison of diagnostic value of modified fine needle aspiration biopsy and non-negative pressure biopsy under the guidance of high frequency color Doppler ultrasound in thyroid nodules[J]. Journal of Xuzhou Medical University, 2019, 39(6): 454-457.
19	SHIN I, KIM E K, MOON H J, et al. Core-needle biopsy does not show superior diagnostic performance to fine-needle aspiration for diagnosing thyroid nodules[J]. Yonsei Med J, 2020, 61(2): 161-168.
20	陈杰桓, 郑楠, 刘颖培, 等. 现场快速评估在超声引导下甲状腺结节细针穿刺中的应用价值[J]. 国际医药卫生导报, 2019, 25(11): 1688-1691.
	CHEN J H, ZHENG N, LIU Y P, et al. Application value of rapid on-site evaluation in ultrasound-guide fine needle aspiration biopsy of thyroid[J]. International Medicine and Health Guidance News, 2019, 25(11): 1688-1691.

Item	ROSE+TCT (n=469)	CS+TCT (n=405)	P value
Gender/[n(%)]			0.892
Male	126 (26.9)	113 (27.9)
Female	343 (73.1)	292 (72.1)
Age/year	42.1±4.0	43.2±3.4	0.358
Thyroid puncture site/[n(%)]			0.781
Left thyroid lobe	276 (58.9)	225 (55.6)
Right thyroid lobe	193 (41.1)	180 (44.4)

Item	ROSE+TCT (n=469)	CS+TCT (n=405)	P value
Gender/[n(%)]			0.892
Male	126 (26.9)	113 (27.9)
Female	343 (73.1)	292 (72.1)
Age/year	42.1±4.0	43.2±3.4	0.358
Thyroid puncture site/[n(%)]			0.781
Left thyroid lobe	276 (58.9)	225 (55.6)
Right thyroid lobe	193 (41.1)	180 (44.4)

TBSRTC classification	ROSE+TCT (n=469)	CS+TCT (n=405)
Ⅰ	8 (1.7)	94 (23.2)
Ⅱ	254 (54.2)	199 (49.1)
Ⅲ	129 (27.5)	72 (17.8)
Ⅳ	68 (14.5)	39 (9.6)
Ⅴ	9 (1.9)	1 (0.2)
Ⅵ	1 (0.2)	0 (0.0)

TBSRTC classification	ROSE+TCT (n=469)	CS+TCT (n=405)
Ⅰ	8 (1.7)	94 (23.2)
Ⅱ	254 (54.2)	199 (49.1)
Ⅲ	129 (27.5)	72 (17.8)
Ⅳ	68 (14.5)	39 (9.6)
Ⅴ	9 (1.9)	1 (0.2)
Ⅵ	1 (0.2)	0 (0.0)

[1]	王娟, 陈其谋, 刘其聪, 陈光敏, 蒋鹏, 张瑞, 周厚地. 急性化脓性甲状腺炎1例报道并文献复习[J]. 上海交通大学学报（医学版）, 2022, 42(10): 1504-1510.
[2]	程晨, 范坤, 张瑛. 超声引导下颈部迷走神经阻滞联合胸椎旁阻滞在胸腔镜手术中的应用[J]. 上海交通大学学报(医学版), 2021, 41(1): 66-69.
[3]	岳秀慧，孔维丹，任继亮，袁瑛#，陶晓峰#. 3.0-T磁共振扩散加权成像联合动态增强成像对甲状腺良恶性结节的鉴别价值[J]. 上海交通大学学报(医学版), 2020, 40(10): 1393-1397.
[4]	韩蕊君1，杜晶1，陈翠1，朱彩霞1，李凤华1，王家东2. 超声TI-RADS分级联合三维剪切波弹性成像对甲状腺微小癌的诊断效能[J]. 上海交通大学学报（医学版）, 2020, 40(1): 76-.
[5]	金志萍 1，张珊 2，于雪梅 2，陈海冰 3，胡承 3. 社区 2型糖尿病患者甲状腺结节危险因素研究分析[J]. 上海交通大学学报（医学版）, 2018, 38(9): 1066-.
[6]	徐婷，王杰，邵玉国，籍敏，杨莉，何奇. 超声引导下Mammotome乳腺肿块切除1 034例分析[J]. 上海交通大学学报（医学版）, 2016, 36(11): 1632-.
[7]	韩蕊君，李凤华，王燕，等. 声触诊组织成像在甲状腺实性结节鉴别诊断中的应用价值[J]. 上海交通大学学报（医学版）, 2015, 35(6): 864-.
[8]	江珊，徐上妍，宋琳琳，等. 甲状腺结节血供程度与弹性评分的相关性研究[J]. 上海交通大学学报（医学版）, 2015, 35(5): 714-.
[9]	朱玫娟,吴玮,王祥瑞. 超声引导选择性颈神经根阻滞治疗老年颈源性疼痛的效果观察[J]. 上海交通大学学报（医学版）, 2015, 35(12): 1919-.
[10]	郑瑜，石有振，李蒙森，等. 超声引导下细针穿刺活检对甲状腺小结节的诊断价值[J]. 上海交通大学学报（医学版）, 2014, 34(8): 1186-.
[11]	郑斌，詹维伟，倪晓枫，等. 超声引导下细针穿刺抽吸活检对TI-RADS 4类甲状腺结节的诊断价值[J]. 上海交通大学学报（医学版）, 2014, 34(8): 1206-.
[12]	贾晓红，周俊宇，徐上妍，等. 甲状腺结节常规超声甲状腺影像报告和数据系统描述词的观察者一致性研究[J]. 上海交通大学学报（医学版）, 2013, 33(7): 1006-.
[13]	周季兰, 邢晋放, 金宇飚, 等. 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[J]. , 2010, 30(11): 1397-.

现场快速评估法辅助超声引导下甲状腺细针穿刺的研究

Study on ultrasound-guided thyroid fine needle puncture assisted by rapid on-side evaluation

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 20

相关文章 13

编辑推荐

Metrics