外科医生进行了甲状腺超声引导下细针穿刺抽吸：教学中心的1067例活检及学习曲线

Surgeon performed ultrasound-guided fine-needle aspirates of the thyroid: 1067 biopsies and learning curve in a teaching center.

作者信息

Fernandes Vinay T, Magarey Matthew J R, Kamdar Dev P, Freeman Jeremy L

机构信息

Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.

Peter MacCallum Cancer Centre, Melbourne, Australia.

出版信息

Head Neck. 2016 Apr;38 Suppl 1:E1281-4. doi: 10.1002/hed.24212. Epub 2015 Aug 28.

DOI:10.1002/hed.24212

PMID:26316053

Abstract

BACKGROUND

Surgeon performed ultrasound-guided fine-needle aspirates (UG-FNAs) reduce delay in diagnosis and allow for surgeon surveillance. We present the first report on a learning curve and impact of head and neck surgical trainees on adequacy rates.

METHODS

Thyroid UG-FNA biopsies from 2009 to 2013 were reviewed retrospectively. Specimen adequacy, cytologic diagnosis, and surgical pathology were used to calculate adequacy and accuracy.

RESULTS

One thousand sixty-seven biopsies were examined in 723 individuals. The adequacy rate from adoption into practice improved from 71% to 78% to 85% over 300 cases. When UG-FNA was subsequently taught to trainees, adequacy rates varied among trainees (p < .037), and there were higher nondiagnostic rates earlier in training (p = .04). Adequacy was not related to size or palpability, but cystic lesions yielded more inadequate specimens (p < .001).

CONCLUSION

Surgeon performed UG-FNA biopsy can be performed adequately in an outpatient setting. Adequacy rates reach acceptable levels after 300 cases, whereas trainee involvement impacts adequacy rates. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1281-E1284, 2016.

摘要

背景

外科医生实施的超声引导下细针穿刺抽吸术（UG-FNA）可减少诊断延迟并便于外科医生进行监测。我们首次报告了学习曲线以及头颈外科实习生对取材充足率的影响。

方法

回顾性分析2009年至2013年期间的甲状腺UG-FNA活检病例。利用标本取材充足情况、细胞学诊断和手术病理结果来计算取材充足率和准确率。

结果

对723例患者的1067次活检进行了检查。在300例病例中，从开始应用到实际操作，取材充足率从71%提高到78%，再到85%。随后当向实习生传授UG-FNA技术时，不同实习生的取材充足率存在差异（p < 0.037），且在培训早期未诊断率较高（p = 0.04）。取材充足与否与结节大小或是否可触及无关，但囊性病变的标本取材不足更多见（p < 0.001）。