袁明+徐月阳

【摘要】 目的：探讨超声引导下活检针穿刺对可疑甲状腺癌结节的诊断价值。方法：在512例患有可疑甲状腺癌结节的患者中，按完全随机设计的原则抽取120例作为研究对象，在术前均行超声引导下活检针穿刺术。计算kappa值、准确率、灵敏度、特异度、漏诊率、误诊率、阳性预测值、阴性预测值、约登指数、阳性似然比、阴性似然比。结果：经术后病理证实84例为甲状腺癌，活检针穿刺正确79例，漏诊5例，不能确定5例。kappa值0.844、一致率0.933、灵敏度0.94、特异度0.917、漏诊率0.06、误诊率0.083、阳性预测值0.963、阴性预测值0.868、阳性似然比11.286、阴性似然比0.065、约登指数0.857。结论：超声引导下活检针穿刺对可疑甲状腺癌结节有较高的诊断价值，可作为判断良恶性结节的首选。

【关键词】 B超引导； 活检针穿刺； 甲癌结节

【Abstract】 Objective：To assess the clinical significance of ultrasonography-guided needle aspiration biopsy in the gland suspected of thyroid carcinoma. Method：120 patients were selected the subject investigated in the principle of completely randomized design from 512 patients who were suspected of getting thyroid carcinoma. And all the subjects were received the Ultrasound-guided needle aspiration biopsy before the operation.Epidemiological indicators of concordance rate， kappa value，sensitivity，specificity，omission diagnostic rate， misdiagnosis rate，positive likelihood ratio，negative likelihood ratio， positive predictive value，negative predictive value and Youden index were used for evaluating the diagnostic value for thyroid carcinoma. Result：84 patients had been pathologically confirmed as thyroid carcinoma. 79 patients were correctly recognized，5 cases were missed diagnosis and another 5 cases were not sure by ultrasonography-guided needle aspiration biopsy. The kappa value， concordance rate， sensitivity， specificity，omission diagnostic rate，misdiagnosis rate，positive predictive value，negative predictive value positive likelihood ratio， negative likelihood ratio，and Youden index were 0.844，0.933，0.94，0.917，0.06，0.083，0.963，0.868，11.286，0.065，0.857.Conclusion：Ultrasonography-guided needle aspiration biopsy has a great significance for the diagnosis of thyroid carcinoma and can be used as the first choice for the identification of the thyroid gland which is suspected of malignancy.

【Key words】 Ultrasonography-guided； Needle aspiration biopsy； Gland of thyroid carcinoma

甲状腺结节是临床上最常见的甲状腺疾病，4%～8% 的成年人触诊发现有甲状腺结节，超声发现人群约30%～50%有甲状腺结节，其中5%～6.5%的结节为恶性[1-3]。明确甲状腺结节性质及来源对指导临床诊断及治疗有重要意义。近年来，在超声引导下细针穿刺对甲状腺结节细胞学检查已做了大量研究[4-8]，但超声引导下活检针穿刺对可疑甲癌结节的病理学检查研究相对不多，并且报道数据各异。本文旨在评估超声引导下活检针穿刺对可疑甲状腺癌结节的诊断价值。

1 资料与方法

1.1 一般资料 收集2009年1月-2014年1月在本院彩超示可疑甲状腺癌结节的512例患者资料，按完全随机设计的原则抽取120例作为研究对象并在术前均行超声引导下活检针穿刺术。……