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薄层液基细胞学涂片在超声引导下甲状腺细针抽吸活检的应用

李文波,  朱庆莉,  姜玉新,  戴晴,  孙健,  张波,  杨萌

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文章导航 > 协和医学杂志  > 2014 >  5(1): 8-12
李文波, 朱庆莉, 姜玉新, 戴晴, 孙健, 张波, 杨萌. 薄层液基细胞学涂片在超声引导下甲状腺细针抽吸活检的应用[J]. 协和医学杂志, 2014, 5(1): 8-12. doi: 10.3969/j.issn.1674-9081.2014.01.003
引用本文: 李文波, 朱庆莉, 姜玉新, 戴晴, 孙健, 张波, 杨萌. 薄层液基细胞学涂片在超声引导下甲状腺细针抽吸活检的应用[J]. 协和医学杂志, 2014, 5(1): 8-12. doi: 10.3969/j.issn.1674-9081.2014.01.003
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Wen-bo LI, Qing-li ZHU, Yu-xin JIANG, Qing DAI, Jian SUN, Bo ZHANG, Meng YANG. Application of a Thin-layer Liquid-based Technique in Ultrasound-guided Fine Needle Aspiration of Thyroid[J]. Medical Journal of Peking Union Medical College Hospital, 2014, 5(1): 8-12. doi: 10.3969/j.issn.1674-9081.2014.01.003
Citation: Wen-bo LI, Qing-li ZHU, Yu-xin JIANG, Qing DAI, Jian SUN, Bo ZHANG, Meng YANG. Application of a Thin-layer Liquid-based Technique in Ultrasound-guided Fine Needle Aspiration of Thyroid[J]. Medical Journal of Peking Union Medical College Hospital, 2014, 5(1): 8-12. doi: 10.3969/j.issn.1674-9081.2014.01.003
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薄层液基细胞学涂片在超声引导下甲状腺细针抽吸活检的应用

doi: 10.3969/j.issn.1674-9081.2014.01.003
  • 1.

    中国医学科学院 北京协和医学院 北京协和医院 超声医学科, 北京 100730

  • 2.

    中国医学科学院 北京协和医学院 北京协和医院 病理科, 北京 100730

基金项目: 

国家高技术研究发展计划(863计划) 2006AA02Z4B3

国家自然科学基金 81171354

北京市科技新星计划 Z131107000413063

详细信息
    通讯作者:

    姜玉新 电话:010-69155491, E-mail:jiangyuxinxh@163.com

  • 中图分类号: R445.1

Application of a Thin-layer Liquid-based Technique in Ultrasound-guided Fine Needle Aspiration of Thyroid

  • 1.

    Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 2.

    Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

More Information

    摘要
  • 摘要:   目的  探讨薄层液基细胞学涂片技术在超声引导下甲状腺穿刺中的应用价值。  方法  2008年1月至7月57例患者的57个甲状腺病变进行超声引导下细针抽吸细胞学检查并同时进行薄层液基细胞学涂片。其中14例获得手术病理, 其余病例全部进行临床随访, 随访时间5年至5年6个月。细胞学及组织学诊断结果分为四类:良性、恶性、可疑恶性及涂片不满意, 将其与手术病理及临床随访结果进行对照分析, 分析薄层液基细胞学涂片的细胞学特征及对甲状腺结节的诊断价值。  结果  薄层液基细胞学涂片与常规细胞学涂片特征有一定差异, 主要表现在背景血细胞明显减少、细胞量较多、集中, 胶质量少或浓集、核较深染、细胞皱缩更常见、常见细胞质碎片及裸核。57个甲状腺病变中, 经手术病理及临床随访证实恶性6个, 良性51个。薄层液基细胞学涂片诊断良性48个(84.2%), 恶性4个(7.0%), 涂片不满意5个(8.8%)。该技术诊断甲状腺恶性结节的敏感性66.7%, 特异性100%, 准确率94.5%, 阳性预测值100%, 阴性预测值96.2%。与常规细胞学涂片诊断结果相似。  结论  薄层液基细胞学涂片细胞学特征与常规涂片有一定差异, 诊断准确性与常规涂片相似, 在甲状腺结节细针抽吸细胞学检查中有较好的应用价值。
    Abstract:   Objective  To investigate the usefulness of the thin-layer liquid-based cytology in ultrasound-guided fine needle aspiration (UG-FNA) of thyroid gland lesions.  Methods  From January 2008 to July 2008, 57 thyroid lesions from 57 patients aged from 18 to 78 in Peking Union Medical College Hospital were sampled by ultrasound-guided fine needle aspiration. The cytologic materials were prepared for both conventional and thin-layer liquid-based cytology by PRPSTAIN Processor (Tripath Imaging, BD, USA). All cytological diagnoses were compared with those confirmed by surgical pathology and clinical follow-up. The UG-FNA results were classified as benign, malignant, suspicious, or unsatisfactory. The various cytologic features on liquid-based cyto-logy and conventional preparation were compared.  Results  Cytomorphologic features showed some differences between the two methods. Liquid-based cytology slides had a clear background and less or dense colloid. It demonstrated more cell shrinkage and showed increased disruption of the cytoplasm and numerous naked nuclei. Among the 57 thyroid lesions, surgical pathology and clinical follow-up confirmed that 6 were malignant and 51 were benign. The thin-layer technology showed that 48 (84.2%) were benign, 4 (7.0%) were malignant, and 5(8.8%)were unsatisfactory for interpretation. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 66.7%, 100%, 94.5%, 100%, and 96.2%, respectively, which were similar with conventional method.  Conclusions  Liquid-based cytology technique has certain different cellular features when compared with conventional smears but with similar diagnostic accuracy. It is an accurate and reliable method for the preoperative cytological diagnosis of thyroid nodules.
    • HTML全文

  • 图  1  甲状腺乳头状癌的传统细胞学涂片和薄层液基细胞学涂片检查(HE染色，×600)

    A.传统细胞学涂片示细胞核呈椭圆形，毛玻璃样核，可见核沟与核内假包涵体；B.薄层液基细胞学涂片示背景血细胞明显减少；核皱缩，染色质浓集，核型不规则；可见核沟

    下载: 全尺寸图片 幻灯片

    图  2  甲状腺淋巴瘤薄层液基细胞学涂片检查(巴氏染色，×300)

    可见大量淋巴细胞，淋巴细胞呈异型性，未见明确甲状腺滤泡上皮；手术病理为甲状腺非霍奇金淋巴瘤

    下载: 全尺寸图片 幻灯片

    表  1  薄层液基细胞学涂片与传统细胞学涂片特征差异

    涂片方法 背景 细胞量 胶质 细胞保持状态与细胞形态 甲状腺乳头状癌特征
    传统细胞学
    涂片    		 大量红细胞 差异较大 充足 滤泡细胞形态保持良好 核增大明显，可见核沟
    薄层液基细
    胞学涂片    		 较干净 较充足、
    集中    		 明显减少，浓染，
    呈碎片状或滴状    		 细胞退变较常见，细胞皱缩，细胞质
    破碎常见，核深染，裸核常见    		 核增大不明显，核不规则更明显，胞浆
    内假包涵体少见，可见核沟
    下载: 导出CSV

    表  2  甲状腺结节超声引导下细针穿刺细胞学涂片与病理及临床随访结果

    细胞学涂片结果 手术病理和临床随访结果
    恶性 良性
    传统细胞学涂片    
       恶性 3 0
       可疑恶性 1 0
       良性 1 46
       不满意 1 5
       合计 6 51
    薄层液基细胞学涂片    
       恶性 4 0
       可疑恶性 0 0
       良性 0 48
       不满意 2 3
       合计 6 51
    下载: 导出CSV
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  • 收稿日期:  2013-10-31
  • 刊出日期:  2014-01-30

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