Solymosi T, Toth G L, Bodo M
Thyroid Outpatient Department, Bugat Hospital, Gyöngyös, Hungary.
Acta Cytol. 2001 Sep-Oct;45(5):669-74. doi: 10.1159/000328285.
To determine the impact of ultrasonography on the diagnostic accuracy of fine needle aspiration cytology (FNAC) of the thyroid.
We compared two FNAC series. In period 1 we used neither ultrasonograph nor ultrasonographically-guided FNAC in the evaluation of thyroid nodules, while both tools were routinely applied in period 2. Moreover, in the former period all cellular follicular lesions were encountered among suspicious findings, while in period 2 we advised regular follow-up examinations instead of immediate surgery for patients with no significant atypia. The basis of follow-up examinations was ultrasonographic volumetry of the nodule and repeat FNAC on growing nodules.
The number of FNAC, positive predictive value of FNAC, number of malignancies, sensitivity, the specificity and diagnostic accuracy were higher in period 2 as compared with period 1: 3,446 vs. 1,448; 45% vs. 16%, 39 vs. 29, 92% vs. 76%, 65% vs. 87% and 66% vs. 87%, respectively.
The introduction of ultrasonography permits higher diagnostic accuracy of the evaluation process. This is achieved not only by lessening false negative reports but, more important, by decreasing false positive results.
确定超声检查对甲状腺细针穿刺活检（FNAC）诊断准确性的影响。
我们比较了两个FNAC系列。在第一阶段，我们在评估甲状腺结节时既未使用超声检查也未采用超声引导下的FNAC，而在第二阶段则常规应用这两种工具。此外，在第一阶段，所有细胞性滤泡病变均出现在可疑结果中，而在第二阶段，对于无明显异型性的患者，我们建议进行定期随访检查而非立即手术。随访检查的依据是结节的超声体积测量以及对生长性结节重复进行FNAC。
与第一阶段相比，第二阶段的FNAC数量、FNAC的阳性预测值、恶性肿瘤数量、敏感性、特异性和诊断准确性更高，分别为3446对1448；45%对16%，39对29，92%对76%，65%对87%以及66%对87%。
超声检查的引入可提高评估过程的诊断准确性。这不仅通过减少假阴性报告实现，更重要的是通过降低假阳性结果来实现。
