Bugis S P, Young J E, Archibald S D, Chen V S
Am J Surg. 1986 Oct;152(4):411-6. doi: 10.1016/0002-9610(86)90314-4.
Fine-needle aspiration biopsy is widely used in the diagnosis and management of the solitary thyroid nodule. It is the most accurate tool available and decreases the need for ultrasonography and thyroid scanning. In those patients who are selected for surgical treatment by fine-needle aspiration biopsy, it has been advocated as a guide to determining the extent of operation. Frozen section, which usually serves as the surgeon's guide, and fine-needle aspiration biopsy both have varying accuracy rates. Few direct comparisons have been made. We studied 198 aspirates in 198 patients who presented with a solitary nodule and had surgical excision. Fine-needle aspiration biopsy (198 cases) and frozen section (182 cases) were compared with the final histologic diagnosis. Accuracy rates for fine-needle aspiration biopsy and frozen section were 90 percent and 95 percent, respectively. Fine-needle aspiration biopsy detected 43 percent of the cancers and frozen section, 64 percent. There were no false-positive diagnoses with frozen section, but three cases with fine-needle aspiration biopsy. The false-negative diagnosis rate was 5 percent for frozen section and 8.5 percent for fine-needle aspiration biopsy. When the "other" diagnosis category was grouped with the "positive" diagnosis category and a single expert cytopathologist was used to read the cytology report, the sensitivity was increased to 80 percent whereas the accuracy was maintained at 83 percent. We believe that since there were no false-positive diagnosis using frozen section, it can reliably be used as a guide when it reveals malignancy. When the fine-needle aspiration biopsy diagnosis is "positive" or "other," it can guide operation, but only after carefully assessing the wording of the cytology report and the clinical situation. Each modality can provide information missed by the other. We continue to use them as complementary tools in the diagnosis and management of solitary thyroid nodules.
细针穿刺活检广泛应用于孤立性甲状腺结节的诊断和处理。它是现有的最准确的工具，减少了超声检查和甲状腺扫描的必要性。在那些通过细针穿刺活检选择手术治疗的患者中，它被提倡作为确定手术范围的指南。通常作为外科医生指南的冰冻切片和细针穿刺活检都有不同的准确率。很少有直接比较。我们研究了198例有孤立性结节并接受手术切除的患者的198份穿刺物。将细针穿刺活检（198例）和冰冻切片（182例）与最终组织学诊断进行比较。细针穿刺活检和冰冻切片的准确率分别为90%和95%。细针穿刺活检检测出43%的癌症，冰冻切片检测出64%。冰冻切片没有假阳性诊断，但细针穿刺活检有3例假阳性诊断。冰冻切片的假阴性诊断率为5%，细针穿刺活检为8.5%。当“其他”诊断类别与“阳性”诊断类别归为一组，并由一位专家细胞病理学家阅读细胞学报告时，敏感性提高到80%，而准确率保持在83%。我们认为，由于冰冻切片没有假阳性诊断，当显示为恶性时，它可以可靠地用作指南。当细针穿刺活检诊断为“阳性”或“其他”时，它可以指导手术，但只有在仔细评估细胞学报告的措辞和临床情况之后。每种方法都能提供另一种方法遗漏的信息。我们继续将它们用作孤立性甲状腺结节诊断和处理的补充工具。
