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
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现场快速评估法
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超声引导
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细针穿刺
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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.
Keywords：thyroid nodule
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rapid on-side evaluation (ROSE)
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ultrasonic guidance
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fine needle aspiration
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cell mass
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. Journal of Shanghai Jiao Tong University (Medical Science)[J], 2023, 43(8): 1032-1037 doi:10.3969/j.issn.1674-8115.2023.08.011
根据ROSE下的细胞学诊断，Bethesda报告系统（The Bethesda System for Reporting Thyroid Cytopathology，TBSRTC）细胞学分类标准［10］Ⅲ级及以上均做细胞蜡块，剩余部分置于TCT保存液。行666×g离心10 min，弃上清液，加琼脂浆，震荡，离心待凉，取出，剔除多余琼脂，切成3片，常规脱水，包埋，切片，苏木精-伊红染色（hematoxylin-eosin staining，H-E染色），制成的蜡块待用。
Note：A/B. TCT smear (A) and DIff-Quik staining smear (B) by ROSE (×100). C. TCT smear (×100). D. CS smear (×100). E/F. Cell wax block (E) and H-E staining (F) by ROSE (×200).
综上，ROSE辅助的超声引导下甲状腺细针穿刺可确保涂片的细胞数量充足，有效提高了标本满意度，而且对细胞学分类Ⅲ级及以上者制作蜡块切片，有利于病理医师准确诊断，便于后续开展免疫组化和苏氨酸特异性激酶（serine-threonine protein kinase，BRAF）、V600及端粒酶反转录酶（telomerase reverse transcriptase，TERT）启动子突变的检测，为临床病患的个体化治疗提供依据，值得普遍推广。但本研究亦存在不足，如样本分流后细胞数量变少，对蜡块制作有一定的难度，今后将进一步优化。
The study was designed by HE Yujie. The manuscript was drafted and revised by HE Yujie and REN Hongzheng. The research implementation and data analysis were carried out by SHI Chao, DING Jun, ZHANG Qiaochu, YAO Yongqiang, ZHANG Zhili, and FAN Lingrui. All the authors have read the last version of paper and consented for submission.
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COMPETING INTERESTS
All authors disclose no relevant conflict of interests.
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