Wang Dan, Fu Hui-Jun, Xu Hui-Xiong, Guo Le-Hang, Li Xiao-Long, He Ya-Ping, Bo Xiao-Wan, Zhao Chong-Ke, Sun Li-Ping, Lu Feng, Zhang Kun, Wei Qing
Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.
Thyroid Institute, Tongji University School of Medicine, Shanghai, China.
Clin Hemorheol Microcirc. 2017;66(1):67-81. doi: 10.3233/CH-160222.
To compare the sampling efficiency and diagnostic performance of ultrasound (US)-guided fine-needle aspiration cytology (FNAC) and fine-needle non-aspiration cytology (FNNAC) for thyroid nodules.
629 thyroid nodules in 629 cases (477 females, 152 males) were randomly subjected to FNAC or FNNAC from Jun 2014 to Feb 2015. Diagnostic performance was calculated in reference to the histological findings or follow-up results.
629 patients (152 men, 477 women) with 629 thyroid nodules were enrolled in the study. Pathological results were obtained in 173 nodules and benign nodules at FNA with more than six months' follow-up were found in 65 nodules. Tumor size for FNAC ranges from 3.0 to 51.0 mm (mean±SD; 10.2±6.9 mm); whereas FNNAC (2.0-43.0 mm; 11.9±7.7 mm). Non-diagnostic results were found in 7.59% (24/316) of FNNAC procedures and 7.59% (25/313) of FNAC (P > 0.05). Determinate and indeterminate results were found in 50.63% (160/316) and 41.77% (132/316) of FNNAC procedures, whereas 58.15% (182/313) and 33.87% (106/313) of FNAC (P < 0.05). In order to obtain determinate cytological results, FNAC might be more suitable than FNNAC for diagnosis of nodules with hypovascularity (51.38% vs. 41.78%, P < 0.05) and macrocalcifications (9.72% vs. 6.50%, P < 0.05). No US and Color-Doppler US characteristics, such as the presence of hypervascularity (P > 0.05), microcalcifications (P > 0.05), internal component (P > 0.05), or size(P > 0.05), were significantly different to obtain determinate cytological results between the FNAC and FNNAC groups. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy of FNAC and FNNAC were as follows: 96.67% vs. 100%, 89.74% vs. 96.5%, 87.88% vs. 96.97%, 97.22% vs. 100%, 92.75% vs.98.36%, respectively (all P > 0.05).
Both FNAC and FNNAC are effective for diagnosis of thyroid nodules. However, FNAC is more effective than FNNAC to acquire determinate cytological results for nodules which US present hypovascularity and macrocalcifications.
比较超声（US）引导下细针穿刺抽吸细胞学检查（FNAC）和细针非抽吸细胞学检查（FNNAC）对甲状腺结节的取样效率和诊断性能。
2014年6月至2015年2月，对629例患者的629个甲状腺结节（477例女性，152例男性）随机进行FNAC或FNNAC检查。参照组织学结果或随访结果计算诊断性能。
本研究纳入629例患者（152例男性，477例女性）的629个甲状腺结节。173个结节获得病理结果，65个结节在FNA后随访超过6个月发现为良性结节。FNAC的肿瘤大小范围为3.0至51.0毫米（均值±标准差；10.2±6.9毫米）；而FNNAC为（2.0 - 43.0毫米；11.9±7.7毫米）。FNNAC操作中有7.59%（24/316）和FNAC中有7.59%（25/313）为非诊断性结果（P>0.05）。FNNAC操作中确定性和不确定性结果分别为50.63%（160/316）和41.77%（132/316），而FNAC分别为58.15%（182/313）和33.87%（106/313）（P<0.05）。为了获得确定性细胞学结果，对于血管少的结节（51.38%对41.78%，P<0.05）和有粗大钙化的结节（9.72%对6.50%，P<0.05），FNAC可能比FNNAC更适合诊断。在获得确定性细胞学结果方面，FNAC组和FNNAC组之间的超声和彩色多普勒超声特征，如是否存在血管丰富（P>0.05）、微钙化（P>0.05）、内部成分（P>0.05）或大小（P>0.05），均无显著差异。FNAC和FNNAC的敏感性、特异性、阳性预测值、阴性预测值、准确性分别如下：96.67%对100%，89.74%对96.5%，87.88%对96.97%，97.22%对100%，92.75%对98.36%（均P>0.05）。
FNAC和FNNAC对甲状腺结节诊断均有效。然而，对于超声显示血管少和有粗大钙化的结节，FNAC在获得确定性细胞学结果方面比FNNAC更有效。
