Liu Q, Castelli M, Gattuso P, Prinz R A
Department of General Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA.
Am Surg. 1995 Jul;61(7):628-32; discussion 632-3.
To evaluate the efficacy of simultaneous fine-needle aspiration (FNA) and core-needle (CN) biopsies of thyroid nodules, the clinical course and operative findings in 100 patients having both tests were reviewed. Each patient had a diagnosis made with this approach. Both specimens were adequate for diagnosis in 95 patients. In the remaining 5 patients, a diagnosis was provided by FNA in four and CN biopsy in one. FNA and CN biopsies gave the same diagnosis of either a benign nodule in 53 patients or neoplasia in 30 patients. When both FNA and CN biopsies showed a benign nodule, a nonoperative approach was taken in 43 of the 53 patients. Forty-two patients were operated on either because of biopsy findings (32) or clinical indications (10). The surgical specimens were used to determine the false positive and false negative rates, the sensitivity, specificity, and accuracy for the diagnosis of neoplasia. The false (+) and false (-) rates in diagnosing neoplasia were 33 per cent and 7 per cent for FNA, 20 per cent and 4 per cent for CN biopsy, and 20 per cent and 0 per cent for both. The sensitivity, specificity, and accuracy for FNA were 93 per cent, 67 per cent, and 83 per cent, for CN biopsy 96 per cent, 80 per cent, and 90 per cent, and 100 per cent, 80 per cent, and 93 per cent for both FNA and CN. All neoplasms were detected, and no thyroid carcinomas were missed by this combination. There was only one complication: bleeding after a CN biopsy. Combined FNA and CN biopsies allow most patients with thyroid nodules to avoid an unnecessary operation and accurately diagnose those with thyroid carcinoma. These two procedures are safe and complementary.
为评估甲状腺结节同步细针穿刺（FNA）活检和粗针（CN）活检的疗效，对100例行这两种检查的患者的临床病程及手术结果进行了回顾。每位患者均通过该方法获得诊断。95例患者的两种标本均足以用于诊断。其余5例患者中，4例通过FNA获得诊断，1例通过CN活检获得诊断。FNA和CN活检对53例良性结节或30例肿瘤均给出了相同的诊断。当FNA和CN活检均显示为良性结节时，53例患者中有43例采取了非手术治疗。42例患者因活检结果（32例）或临床指征（10例）接受了手术。手术标本用于确定肿瘤诊断的假阳性率和假阴性率、敏感性、特异性及准确性。FNA诊断肿瘤的假阳性率和假阴性率分别为33%和7%，CN活检分别为20%和4%，两者联合为20%和0%。FNA的敏感性、特异性及准确性分别为93%、67%和83%，CN活检分别为96%、80%和90%，FNA和CN联合分别为100%、80%和93%。所有肿瘤均被检测到，该联合检查未漏诊任何甲状腺癌。仅发生1例并发症：CN活检后出血。FNA和CN活检联合可使大多数甲状腺结节患者避免不必要的手术，并准确诊断甲状腺癌患者。这两种检查方法安全且互补。
