Fernandes Vinay T, De Santis Robert J, Enepekides Danny J, Higgins Kevin M
Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada.
Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada.
J Otolaryngol Head Neck Surg. 2015 Oct 28;44:42. doi: 10.1186/s40463-015-0099-x.
Fine-needle aspiration biopsy has become the standard of care for the evaluation of thyroid nodules. More recently, the use of ultrasound guided fine-needle aspiration biopsy (UG-FNAB) has improved adequacy of sampling. Now there has been improved access to UG-FNAB as ultrasound technology has become more accessible. Here we review the adequacy rate and learning curve of a single surgeon starting at the adoption of UG-FNAB into surgical practice.
UG-FNABs performed at Sunnybrook Health Sciences Centre from 2010 to 2015 were reviewed retrospectively. Nodule characteristics were recorded along with cytopathology and final pathology reports. Chi-square analysis, followed by the reporting of odds ratios with confidence intervals, were used to assess the statistical significance and frequencies, respectively, of nodule characteristics amongst both diagnostic and non-diagnostic samples. A multiple regression analysis was conducted to determine if any nodule characteristic were predictive of adequacy of UG-FNABs. The learning curve was assessed by calculating the eventual adequacy rates across each year, and its statistical significance was measured using Fischer's Exact Test.
In total 423 biopsies were reviewed in 289 patients. The average nodule size was 23.05 mm. When examining if each patient eventually received a diagnostic UG-FNAB, regardless of the number attempts, adequacy was seen to increase from 70.8% in 2010 to, 81.0% in 2011, 90.3% in 2012, 85.7% in 2013, 89.7% in 2014, and 94.3% in 2015 (Fischer's Exact Test, p = 0.049). Cystic (χ(2) = 19.70, p <0.001) nodules were found to yield higher rates of non-diagnostic samples, and their absence are predictive of obtaining an adequate biopsy as seen in a multiple regression analysis (p < 0.001) Adequacy of repeat biopsies following an initial non-diagnostic sample was 75.0%.
Surgeons are capable of performing UG-FNAB with a learning curve noted to achieve standard adequacy rates. Cystic nodules are shown to yield more non-diagnostic samples in the surgeon's office.
细针穿刺活检已成为评估甲状腺结节的标准治疗方法。最近，超声引导下细针穿刺活检（UG-FNAB）的应用提高了采样的充分性。随着超声技术的普及，现在更容易获得UG-FNAB。在此，我们回顾了一名外科医生从将UG-FNAB应用于外科实践开始的采样充分率和学习曲线。
回顾性分析2010年至2015年在桑尼布鲁克健康科学中心进行的UG-FNAB。记录结节特征以及细胞病理学和最终病理学报告。分别采用卡方分析以及报告带有置信区间的比值比，来评估诊断性和非诊断性样本中结节特征的统计学意义和频率。进行多元回归分析以确定是否有任何结节特征可预测UG-FNAB的充分性。通过计算每年最终的充分率来评估学习曲线，并使用费舍尔精确检验测量其统计学意义。
共对289例患者的423次活检进行了回顾。结节平均大小为23.05毫米。在检查每位患者最终是否获得诊断性UG-FNAB时（无论尝试次数），充分率从2010年的70.8%提高到2011年的81.0%、2012年的90.3%、2013年的85.7%、2014年的89.7%以及2015年的94.3%（费舍尔精确检验，p = 0.049）。发现囊性结节（χ(2)=19.70，p<0.001）产生非诊断性样本的比例更高，在多元回归分析中，无囊性结节可预测获得充分活检（p<0.001）。初次非诊断性样本后重复活检的充分率为75.0%。
外科医生能够进行UG-FNAB，其学习曲线显示可达到标准的充分率。在外科医生办公室中，囊性结节显示会产生更多非诊断性样本。
