细针穿刺细胞学检查与冰冻切片活检在甲状腺结节诊断中的相关性
Correlation of fine needle aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules.
作者信息
Chang H Y, Lin J D, Chen J F, Huang B Y, Hsueh C, Jeng L B, Tsai J S
机构信息
Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan Hsien, Taiwan, Republic of China.
出版信息
J Clin Pathol. 1997 Dec;50(12):1005-9. doi: 10.1136/jcp.50.12.1005.
AIMS
To evaluate the correlation of fine needle aspiration (FNA) cytology and frozen section biopsy in the diagnosis of thyroid nodules.
METHODS
The medical records of 662 patients who underwent FNA cytology of the thyroid and thyroid surgery were analysed. Frozen section biopsies were taken from 586 of the 662 patients. The diagnostic correlations of FNA cytology, frozen section, and both FNA cytology and frozen section with definitive histological assessment were evaluated.
RESULTS
Among the 662 patients who received FNA cytology, there were 356 cases (53.8%) diagnosed as benign, 114 cases (17.2%) as malignant, 148 cases (22.4%) as indeterminate, and 44 cases (6.6%) as unsatisfactory. The positive predictive value for the detection of malignancy by FNA cytology was 92.1% and the negative predictive value was 95.2%. The incidence of malignancy in the indeterminate cytological diagnosis was 23%. The diagnosis from frozen sections was benign in 445 cases (75.9%), malignant in 134 cases (22.9%), and deferred in 7 cases (1.2%). By frozen section, the positive and negative predictive values were 97% and 95.5%, respectively. Diagnostic accuracy up to 98% was achieved when FNA cytology and frozen section diagnoses were in agreement. No false positives were observed when FNA cytology and frozen sections were both positive for malignancy. When FNA cytology and frozen section diagnoses were discordant, frozen section showed a higher accuracy (78.9%) than FNA cytology (21.1%). In the face of an indeterminate or unsatisfactory cytological diagnosis, the diagnostic accuracy of frozen sections reached 92.6%.
CONCLUSIONS
The results confirm that FNA cytology is a useful tool in the initial evaluation of thyroid nodules. Intraoperative frozen section is a valuable procedure to confirm the cytological diagnosis and identify malignancy in patients with indeterminate or unsatisfactory cytological diagnosis. With reliance on frozen sections as an intraoperative guide of thyroid surgery, the possibility of unnecessary extensive surgery and the need for the second operation are considerably lower.
目的
评估细针穿刺（FNA）细胞学检查与冰冻切片活检在甲状腺结节诊断中的相关性。
方法
分析662例行甲状腺FNA细胞学检查及甲状腺手术患者的病历。662例患者中有586例进行了冰冻切片活检。评估FNA细胞学检查、冰冻切片以及FNA细胞学检查与冰冻切片两者与最终组织学评估的诊断相关性。
结果
在接受FNA细胞学检查的662例患者中，356例（53.8%）诊断为良性，114例（17.2%）为恶性，148例（22.4%）为不确定，44例（6.6%）为不满意。FNA细胞学检查检测恶性肿瘤的阳性预测值为92.1%，阴性预测值为95.2%。不确定细胞学诊断中恶性肿瘤的发生率为23%。冰冻切片诊断为良性445例（75.9%），恶性134例（22.9%），延迟诊断7例（1.2%）。通过冰冻切片，阳性和阴性预测值分别为97%和95.5%。当FNA细胞学检查和冰冻切片诊断一致时，诊断准确率高达98%。当FNA细胞学检查和冰冻切片均为恶性阳性时，未观察到假阳性。当FNA细胞学检查和冰冻切片诊断不一致时，冰冻切片显示出比FNA细胞学检查更高的准确率（78.9%）（21.1%）。面对不确定或不满意的细胞学诊断时，冰冻切片的诊断准确率达到92.6%。
结论
结果证实FNA细胞学检查是甲状腺结节初始评估中的有用工具。术中冰冻切片是确认细胞学诊断并识别细胞学诊断不确定或不满意患者中恶性肿瘤的有价值的程序。依靠冰冻切片作为甲状腺手术的术中指导，不必要的广泛手术可能性和二次手术需求显著降低。
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