Wiedemann W, Wurster K, Strohm C
Abteilung für Strahlentherapie und Radiologische Onkologie, Ludwig-Maximilians-Universität München.
Radiologe. 1989 Mar;29(3):109-18.
If properly performed, modern high-resolution real-time ultrasonography will disclose subtle differences in the texture of thyroid tissue and thereby enable the examiner to suggest a diagnosis. Nevertheless, there is often a need for a more specific diagnosis of solid or semisolid thyroid lesions - especially when the lesion might be malignant. Ultrasonically guided fine-needle aspiration biopsy (UG-FNB) allows a final cytological and/or histological diagnosis to be made in patients with benign or malignant space-occupying growths even if they are small. In its simplest form, thyroid nodules (diameter greater than 1.5 cm) with a uniform sonographic texture are punctured blind after determination of the site and size of the lesion on the basis of ultrasonic imaging. When the lesion is small and deeply situated (diameter less than or equal to 1.5 cm), this method will not be sufficiently accurate and more precise needle guidance is mandatory. In ultrasonically guided fine-needle puncture, the idea is to place the tip of an appropriate needle safely and accurately in the suspect lesion, so that representative specimens of solid tissue or fluid can be obtained and technical failures reduced. The main indication for biopsy of the thyroid gland is to differentiate between benign and malignant tumors. To compare the accuracy of conventional puncture techniques and ultrasonically guided puncture methods, 835 patients with benign or malignant space-occupying growth (even the small ones) were examined simultaneously with conventional and ultrasonically guided fine-needle aspiration biopsy over a period of 3 years (prospectively). Our results showed a significant difference in the sensitivity between conventional puncture without sonographic guidance and ultrasonically guided puncture techniques performed on patients with small and very small lesions (phi less than 2 cm). The size, macroscopic structure, and topographic-anatomical localization of the lesions were found to influence the diagnostic accuracy of the puncture techniques. UG-FNB is an excellent, effective, safe and painless method of treating uncomplicated thyroid cysts; it should be considered an alternative to surgery, if there are no clinical and cytological findings indicating malignancy and no severe space-occupying complications. Since the tip of the needle can be visualized on the scan, the needle may be advanced or withdrawn during aspiration so it is possible to empty the cyst completely. The use of ultrasound in the follow-up of patients with thyroid cyst puncture is mandatory to evaluate the results. Surgical therapy should be reserved for large cysts causing space-occupying complications.
如果操作得当，现代高分辨率实时超声检查能够揭示甲状腺组织质地的细微差异，从而使检查者能够提出诊断建议。然而，对于实性或半实性甲状腺病变，往往需要更明确的诊断——尤其是当病变可能为恶性时。超声引导下细针穿刺活检（UG-FNB）能够对患有良性或恶性占位性病变的患者做出最终的细胞学和/或组织学诊断，即使病变很小。其最简单的形式是，在根据超声成像确定病变的部位和大小后，对具有均匀超声纹理的甲状腺结节（直径大于1.5厘米）进行盲目穿刺。当病变较小且位置较深（直径小于或等于1.5厘米）时，这种方法的准确性不足，必须采用更精确的针引导。在超声引导下细针穿刺中，关键是要将合适的针尖端安全准确地置于可疑病变中，以便获取实性组织或液体的代表性标本，并减少技术失误。甲状腺活检的主要指征是区分良性和恶性肿瘤。为比较传统穿刺技术和超声引导穿刺方法的准确性，在3年时间里（前瞻性地），对835例患有良性或恶性占位性病变（即使是小病变）的患者同时进行了传统和超声引导下细针穿刺活检。我们的结果显示，对于小病变（直径小于2厘米）和非常小病变的患者，无超声引导的传统穿刺与超声引导穿刺技术在敏感性上存在显著差异。发现病变的大小、宏观结构和地形解剖定位会影响穿刺技术的诊断准确性。UG-FNB是治疗单纯性甲状腺囊肿的一种出色、有效、安全且无痛的方法；如果没有临床和细胞学检查结果提示恶性，且没有严重的占位性并发症，应将其视为手术的替代方法。由于针尖端在扫描中可见，在抽吸过程中可推进或拔出针，因此有可能将囊肿完全排空。对甲状腺囊肿穿刺患者进行随访时必须使用超声来评估结果。手术治疗应保留给引起占位性并发症的大囊肿。
