Department of Pathology, International Medical University, Kuala Lumpur, Malaysia.
J Environ Pathol Toxicol Oncol. 2013;32(2):149-55. doi: 10.1615/jenvironpatholtoxicoloncol.2013006980.
Fine-needle aspiration (FNA) cytology of the thyroid is usually performed on an outpatient basis. The results of FNA are operator dependent and may be affected by the lesion characteristics and the aspiration technique. In current practice ultrasound (US) is widely used to guide the needle for aspiration of nondominant nodules. Our study aimed to compare the free-hand FNA with US-guided FNA in the evaluation of thyroid nodules. A total of 91 cases of thyroid lesions were studied at the Department of Pathology, Karnataka Institute of Medical Sciences, Hubli, India. All the cases underwent free-hand and US-guided FNA. The cytological samples from both procedures were analyzed for adequacy, cytological features, and possible diagnosis. The results were correlated with histopathological diagnosis whenever possible. Of 91 aspirates, 89 were satisfactory and 2 were unsatisfactory on US-guided FNA, whereas 85 were satisfactory and 6 were unsatisfactory in free-hand FNA. Of 91 cases 68 (74.7%) were nonneoplastic lesions and 21 (23.1%) were neoplastic lesions in US-guided FNA, whereas 67 cases (73.6%) were nonneoplastic and 18 cases (19.8%) were neoplastic in free-hand FNA. Histopathological study was possible in 25 patients, among whom 15 lesions were nonneoplastic and 10 were neoplastic. Sensitivity and specificity of US-guided FNA to detect neoplastic lesions were 81.81% and 92.85%, respectively, compared with free-hand FNA, for which the sensitivity and specificity were 54.54% and 92.85%, respectively. The diagnostic accuracy of guided FNA was 88% against the 76% accuracy rate of free-hand FNA. US-guided FNA provides a better representative sample and has a higher diagnostic rate in the evaluation of thyroid lesions.
甲状腺细针穿刺细胞学检查通常在门诊进行。穿刺结果取决于操作者的技术水平，也可能受到病变特征和穿刺技术的影响。目前，超声（US）广泛用于引导非优势结节的穿刺针。我们的研究旨在比较徒手和超声引导下甲状腺结节细针穿刺活检的诊断效能。在印度卡纳塔克邦医学科学研究所病理科共研究了 91 例甲状腺病变患者。所有患者均接受了徒手和超声引导下的细针穿刺活检。分析两种方法获得的细胞学样本的充足性、细胞学特征和可能的诊断。尽可能将结果与组织病理学诊断进行比较。在 91 例抽吸物中，89 例在超声引导下和 2 例在徒手穿刺下是满意的，而 85 例在徒手和 6 例在超声引导下是不满意的。在 91 例患者中，68 例（74.7%）为非肿瘤性病变，21 例（23.1%）为肿瘤性病变。在超声引导下，67 例（73.6%）为非肿瘤性病变，18 例（19.8%）为肿瘤性病变，而在徒手穿刺下，15 例（19.8%）为非肿瘤性病变，10 例（11.6%）为肿瘤性病变。在 25 例可进行组织病理学检查的患者中，15 例为非肿瘤性病变，10 例为肿瘤性病变。与徒手穿刺相比，超声引导下 FNA 检测肿瘤性病变的敏感性和特异性分别为 81.81%和 92.85%，而徒手穿刺的敏感性和特异性分别为 54.54%和 92.85%。超声引导下 FNA 的诊断准确性为 88%，而徒手穿刺的准确性为 76%。在甲状腺病变的评估中，超声引导下 FNA 可提供更具代表性的样本，诊断率更高。
