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超声引导组织活检对甲状腺病变的诊断价值

王蕾,  朱庆莉,  姜玉新,  李文波,  杨萌,  张晓燕

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文章导航 > 协和医学杂志  > 2014 >  5(1): 13-16
王蕾, 朱庆莉, 姜玉新, 李文波, 杨萌, 张晓燕. 超声引导组织活检对甲状腺病变的诊断价值[J]. 协和医学杂志, 2014, 5(1): 13-16. doi: 10.3969/j.issn.1674-9081.2014.01.004
引用本文: 王蕾, 朱庆莉, 姜玉新, 李文波, 杨萌, 张晓燕. 超声引导组织活检对甲状腺病变的诊断价值[J]. 协和医学杂志, 2014, 5(1): 13-16. doi: 10.3969/j.issn.1674-9081.2014.01.004
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Lei WANG, Qing-li ZHU, Yu-xin JIANG, Wen-bo LI, Meng YANG, Xiao-yan ZHANG. Ultrasound-guided Core-needle Biopsy in the Diagnosis of Thyroid Foci[J]. Medical Journal of Peking Union Medical College Hospital, 2014, 5(1): 13-16. doi: 10.3969/j.issn.1674-9081.2014.01.004
Citation: Lei WANG, Qing-li ZHU, Yu-xin JIANG, Wen-bo LI, Meng YANG, Xiao-yan ZHANG. Ultrasound-guided Core-needle Biopsy in the Diagnosis of Thyroid Foci[J]. Medical Journal of Peking Union Medical College Hospital, 2014, 5(1): 13-16. doi: 10.3969/j.issn.1674-9081.2014.01.004
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超声引导组织活检对甲状腺病变的诊断价值

doi: 10.3969/j.issn.1674-9081.2014.01.004

  • 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

基金项目: 

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;R581

Ultrasound-guided Core-needle Biopsy in the Diagnosis of Thyroid Foci

  • Department of Ultrasound, 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  评价超声引导组织活检(core-needle biopsy, CNB)对甲状腺病变的诊断价值。  方法  选取2004年11月至2011年6月在北京协和医院就诊的117例进行CNB、有完整手术病理或随访资料的甲状腺病变患者, 回顾性分析其甲状腺病灶的CNB及病理结果。  结果  CNB结果显示, 117例甲状腺病变中良性85例, 恶性28例, 可疑恶性2例, 取材不满意2例, 取材成功率98.3%;弥漫性病变37例, 甲状腺结节80例。29例手术患者术后病理显示恶性24例(22例乳头状癌, 2例淋巴瘤), 其中5例CNB为良性(假阴性); 良性5例。80例甲状腺结节中小于1 cm者2例, 1~2 cm者21例, 大于2 cm者57例。  结论  超声引导CNB取材成功率高, 安全可靠, 可作为超声引导细针抽吸活检(fine needle aspiration, FNA)的有效补充手段, 并可用于特殊甲状腺病理类型, 如淋巴瘤的首选诊断方式。
    Abstract:   Objective  To evaluate the efficacy of ultrasound-guided core-needle biopsy (CNB) in diagnosis of thyroid foci.  Methods  The ultrasound-guided CNB was performed on 117 thyroid foci in Peking Union Medical College Hospital from November 2004 to June 2011. The diagnostic data of 117 thyroid foci were retrospectively analyzed.  Results  All patients completed CNB successfully and the satisfaction rate for tissue samples was 98.3%. The CNB pathologic results of 117 patients were as follows:85 cases were benign, 28 cases were malignant, 2 case were suspected malignant, and 2 cases were inadequate for diagnosis; 37 cases had diffuse lesions and 80 cases had nodules. In 29 patients (including 24 cases of malignancy and 5 cases of benign disease) who had undergone surgery, the CNB pathologic results in 5 cases were false negative compared with the pathologic results of surgery. The diameters of thyroid nodules were less than 1 cm in 2 cases, 1-2 cm in 21 cases, and more than 2 cm in 57 cases.  Conclusions  Ultrasound-guided CNB is valuable for the differential diagnosis of thyroid foci. It is a supplement to the routine fine needle aspiration and can be used for the diagnosis of special thyroid foci such as the thyroid lymphoma.
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  • 图  1  患者女，48岁，甲状腺双侧对称性弥漫性病变，超声引导组织活检示慢性淋巴细胞性甲状腺炎(桥本病)

    A.甲状腺右叶不均质低回声；B.彩色多普勒血流显像

    下载: 全尺寸图片 幻灯片

    图  2  患者女，59岁，右叶甲状腺实性结节(2.4 cm×1.5 cm)，内伴粗大钙化成簇微钙化，超声引导组织活检及手术病理均示甲状腺乳头状癌

    A.结节纵切；B.结节横切；C.结节纵切示粗大钙化灶(箭头)；D.结节横切示成簇微钙化灶(箭头)

    下载: 全尺寸图片 幻灯片

    图  3  患者女，69岁，原发性甲状腺淋巴瘤(弥漫型)，超声示双侧腺体明显增大、呈显著低回声、回声不均匀

    A.右叶纵切；B.彩色多普勒血流示弥漫病灶；C.颈部淋巴结多发转移灶(箭头)；D.彩色多普勒血流示转移淋巴结(箭头)

    下载: 全尺寸图片 幻灯片

    表  1  甲状腺病变组织活检病理分类

    病灶分型 n 良性(n=85)   恶性及可疑恶性(n=30) 取材不满意
    (n=2)
    甲状腺炎
    (桥本病)    		 甲亢 甲状腺肿 腺瘤   乳头状癌 淋巴瘤 可疑淋巴瘤
    弥漫性 37 28(23) 2 2 0   2 1 1 1
    结节性 80 41(14) 0 7 5   20 5 1 1
    合计 117 69(37) 2 9 5   20 5 1 1
    下载: 导出CSV
    • 参考文献(14)
  • [1] Yousaf U, Christensen LH, Rasmussen AK, et al. Immunohistochemical staining for thyroid peroxidase (TPO) of needle core biopsies in the diagnosis of scintigraphically cold thyroid nodules[J]. Clin Endocrinol (Oxf), 2008, 68:996-1001. doi:  10.1111/j.1365-2265.2007.03130.x
    [2] Liu Q, Castelli M, Gattuso P, et al. Simultaneous fine-needle aspiration and core-needle biopsy of thyroid nodules[J]. Am Surg, 1995, 61:628-632. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=0dc9b27d949963f65bea1f6e8977ba24
    [3] Harvey JN, Parker D, De P, et al. Sonographically guided core biopsy in the assessment of thyroid nodules[J]. J Clin Ultrasound, 2005, 33:57-62. doi:  10.1002/jcu.20092
    [4] Screaton NJ, Berman LH, Grant JW. US-guided core-needle biopsy of the thyroid gland[J]. Radiology, 2003, 226:827-832. doi:  10.1148/radiol.2263012073
    [5] Renshaw AA, Pinnar N. Comparison of thyroid fine-needle aspiration and core needle biopsy[J]. Am J Clin Pathol, 2007, 128:370-374. doi:  10.1309/07TL3V58337TXHMC
    [6] Taki S, Kakuda K, Kakuma K, et al. Thyroid nodules:evaluation with US-guided core biopsy with an automated biopsy gun[J]. Radiology, 1997, 202:874-877. doi:  10.1148/radiology.202.3.9051050
    [7] Samir AE, Vij A, Seale MK, et al. Ultrasound-guided percutaneous thyroid nodule core biopsy:clinical utility in patients with prior nondiagnostic fine-needle aspirate[J]. Thyroid, 2012, 22:461-467. doi:  10.1089/thy.2011.0061
    [8] Zhang S, Ivanovic M, Nemcek AA, et al. Thin core needle biopsy crush preparations in conjunction with fine-needle aspiration for the evaluation of thyroid nodules:a complementary approach[J]. Cancer, 2008, 114:512-518. doi:  10.1002/cncr.23982
    [9] Ha EJ, Baek JH, Lee JH, et al. Sonographically suspicious thyroid nodules with initially benign cytologic results:the role of a core needle biopsy[J]. Thyroid, 2013, 23:703-708. doi:  10.1089/thy.2012.0426
    [10] Nasrollah N, Trimboli P, Guidobaldi L, et al. Thin core biopsy should help to discriminate thyroid nodules cytologically classified as indeterminate. A new sampling technique[J]. Endocrine, 2013, 43:659-665. doi:  10.1007/s12020-012-9811-z
    [11] Pitman MB, Abele J, Ali SZ, et al. Techniques for thyroid FNA:a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference[J]. Diagn Cytopathol, 2008, 36:407-424. doi:  10.1002/dc.20829
    [12] Park KT, Ahn SH, Mo JH, et al. Role of core needle biopsy and ultrasonographic finding in management of indeterminate thyroid nodules[J]. Head Neck, 2011, 33:160-165. doi:  10.1002/hed.21414
    [13] Sakorafas GH, Kokkoris P, Farley DR. Primary thyroid lymphoma (correction of lympoma):diagnostic and therapeutic dilemmas[J]. Surg Oncol, 2010, 19:e124-e129. doi:  10.1016/j.suronc.2010.06.002
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出版历程
  • 收稿日期:  2013-10-21
  • 刊出日期:  2014-01-30

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