Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2020 Feb;61(2):161-168. doi: 10.3349/ymj.2020.61.2.161.
To compare the diagnostic performances of fine-needle aspiration (FNA) and core-needle biopsy (CNB) for thyroid nodules according to nodule size.
This retrospective study included 320 thyroid nodules from 320 patients who underwent both FNA and CNB at outside clinics and proceeded with surgery in our institution between July 2012 and May 2019. According to nodule size, the diagnostic performances of FNA and CNB were calculated using various combinations of test-negatives and test-positives defined by the Bethesda categories and were compared using the generalized estimated equation and the Delong method.
There were 279 malignant nodules in 279 patients and 41 benign nodules in 41 patients. The diagnostic performance of FNA was mostly not different from CNB regardless of nodule size, except for negative predictive value, which was better for FNA than CNB when applying Criteria 1 and 2. When applying Criteria 3, the specificity and positive predictive value of FNA were superior to CNB regardless of size. When applying Criteria 4, diagnostic performance did not differ between FNA and CNB regardless of size. After applying Criteria 5, diagnostic performance did not differ between FNA and CNB in nodules ≥2 cm. However, in nodules ≥1 cm and all nodules, the sensitivity, accuracy, and negative predictive value of CNB were better than those of FNA.
CNB did not show superior diagnostic performance to FNA for diagnosing thyroid nodules.
根据结节大小比较细针抽吸（FNA）和核心针活检（CNB）在甲状腺结节诊断中的性能。
本回顾性研究纳入了 2012 年 7 月至 2019 年 5 月在我院行手术治疗的 320 例于外院行 FNA 和 CNB 的甲状腺结节患者的 320 个结节。根据结节大小，通过贝塞斯达分类定义的各种测试阴性和测试阳性组合计算 FNA 和 CNB 的诊断性能，并使用广义估计方程和 Delong 方法进行比较。
279 例患者的 279 个结节为恶性，41 例患者的 41 个结节为良性。除了阴性预测值外，FNA 的诊断性能在大多数情况下与 CNB 无差异，这在应用标准 1 和 2 时 FNA 优于 CNB。应用标准 3 时，FNA 的特异性和阳性预测值优于 CNB，且与结节大小无关。应用标准 4 时，FNA 和 CNB 的诊断性能在所有大小的结节中均无差异。应用标准 5 时，FNA 和 CNB 的诊断性能在≥2cm 的结节中无差异。然而，在≥1cm 和所有结节中，CNB 的敏感性、准确性和阴性预测值均优于 FNA。
CNB 对诊断甲状腺结节的诊断性能并不优于 FNA。
