Divisione di Radiologia, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milano, Italy.
Radiol Med. 2010 Jun;115(4):612-8. doi: 10.1007/s11547-010-0528-x. Epub 2010 Feb 22.
Thyroid nodules are commonly encountered in clinical practice, and ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the gold standard in diagnosing the pathological nature of undetermined thyroid nodules. The aim of this study was to evaluate whether operator experience influences the diagnostic accuracy of US-guided FNAB.
A total of 700 consecutive US-guided FNAB done by a single radiologist between 2000 and 2007 were retrospectively analysed. The same freehand technique and capillary-action technique with 22- or 25-gauge needles was used for all nodules, All specimens were prepared and fixed without the cytologist on site and were subsequently analysed by two expert cytologists. The procedures were chronologically divided into seven groups and classified as diagnostic or nondiagnostic.
The rate of nondiagnostic procedures for each group was 32% in group 1, 13% in group 2, 17% in group 3, 11% in group 4, 10% in group 5, 5% in group 6 and 8% in group 7. No major complications were recorded.
The rate of nondiagnostic US-guided FNAB is heavily dependent on the operator's experience. We estimated that at least 200 procedures need to be performed in order to achieve the levels of diagnostic accuracy reported in the literature. We therefore suggest specific training before operators routinely perform this procedure in clinical practice.
甲状腺结节在临床实践中很常见，超声（US）引导下的细针抽吸活检（FNAB）是诊断未确定甲状腺结节病理性质的金标准。本研究旨在评估操作人员经验是否会影响 US 引导下 FNAB 的诊断准确性。
回顾性分析了 2000 年至 2007 年间由一位放射科医生进行的 700 例连续 US 引导下 FNAB。所有结节均采用相同的徒手技术和毛细作用技术，使用 22 或 25 号针。所有标本均在无细胞病理学家在场的情况下制备和固定，并随后由两位专家细胞病理学家进行分析。该过程按时间顺序分为七组，并分为诊断性或非诊断性。
每组非诊断性操作的比例分别为：第 1 组为 32%，第 2 组为 13%，第 3 组为 17%，第 4 组为 11%，第 5 组为 10%，第 6 组为 5%，第 7 组为 8%。未记录到重大并发症。
US 引导下 FNAB 的非诊断率严重依赖于操作人员的经验。我们估计，至少需要进行 200 例操作，才能达到文献报道的诊断准确性水平。因此，我们建议在操作人员常规在临床实践中进行该操作之前进行特定的培训。
