Wu Maoxin
Department of Pathology, Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
Diagn Cytopathol. 2011 Oct;39(10):743-51. doi: 10.1002/dc.21460. Epub 2010 Oct 14.
Our previous study showed that the sensitivity of head and neck fine-needle aspiration (FNA) procedures was significantly better in the cytopathologist-performed group than in the noncytopathologist-performed group (96 versus 67%). Recently, cytopathologists have learned to use ultrasound machines to assist them in performing FNA procedures. This study was designed to assess whether cytopathologist-performed FNAs with ultrasound guidance can improve diagnostic value in comparison to those done without ultrasound guidance. Two hundred consecutive head and neck FNA cases performed by the same cytopathologist with and without ultrasound guidance were reviewed. Cases consisted of 100 ultrasound-guided FNAs (USGFNAs) performed between July 2008 and March 2009 and 100 palpation-guided FNAs (PGFNAs) performed before July 2008. These cases were correlated with follow-up surgical diagnosis. The diagnostic, suspicious/atypical/suggestive, and nondiagnostic rates (%) for the head and neck FNAs were 83 versus 86, 10 versus 13, and 7 versus 1 in PGFNA group versus USGFNA group, respectively. Surgical follow-up specimens were found in 50 PGFNAs versus 35 USGFNAs. The true-positive, true-negative, false-positive, and false-negative rates (%) were 92, 2, 2, and 4 versus 80, 17, 3, and 0 in PGFNAs versus USGFNAs, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 96, 50, 98, 33, and 94% in PGFNAs versus 100, 86, 97, 100, and 97% in the USGFNA group, respectively. This study also shows increased FNAs of thyroid and salivary glands and other smaller nonpalpable lesions with ultrasound guidance. USGFNAs performed by a cytopathologist could significantly improve the specificity and NPV (P = 0.04) while preserving virtually the same excellent sensitivity and PPV as those of PGFNAs. With ultrasound guidance, a cytopathologist will be able to perform FNAs in smaller, nonpalpable lesions and target complex lesions with confidence and accuracy, thus achieving a better outcome.
我们之前的研究表明，在细胞病理学家操作组中，头颈部细针穿刺（FNA）程序的敏感性显著高于非细胞病理学家操作组（96%对67%）。最近，细胞病理学家已学会使用超声机器辅助他们进行FNA程序。本研究旨在评估细胞病理学家在超声引导下进行的FNA与未在超声引导下进行的FNA相比，是否能提高诊断价值。回顾了由同一位细胞病理学家在有和没有超声引导下连续进行的200例头颈部FNA病例。病例包括2008年7月至2009年3月期间进行的100例超声引导下细针穿刺抽吸术（USGFNA）和2008年7月之前进行的100例触诊引导下细针穿刺抽吸术（PGFNA）。这些病例与后续手术诊断相关。PGFNA组与USGFNA组头颈部FNA的诊断率、可疑/非典型/提示性率和非诊断率（%）分别为83%对86%、10%对13%和7%对1%。PGFNA组有50例和USGFNA组有35例获得手术随访标本。PGFNA与USGFNA的真阳性率、真阴性率、假阳性率和假阴性率（%）分别为92%、2%、[2%]和4%对80%、17%、3%和0%。PGFNA的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为96%、50%、98%、33%和94%，而USGFNA组分别为100%、86%、97%、100%和97%。本研究还表明，在超声引导下甲状腺和唾液腺以及其他较小的不可触及病变的FNA数量增加。细胞病理学家进行的USGFNA可显著提高特异性和NPV（P = 0.04），同时保持与PGFNA几乎相同的出色敏感性和PPV。在超声引导下，细胞病理学家将能够自信且准确地对较小的、不可触及的病变进行FNA，并针对复杂病变，从而获得更好的结果。 （注：原文中false - positive rate处似乎少了一个数字，翻译时保留了原文格式，推测可能是2%，你可根据实际情况确认）
