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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

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
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

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
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

More Information
  • 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。
  • 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

    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

    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
  • [1] Ozel A, Erturk SM, Ercan A, et al. The diagnostic efficiency of ultrasound in characterization for thyroid nodules:how many criteria are required topredict malignancy?[J]. Med Ultrason, 2012, 14:24-28. http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=77415615&site=ehost-live
    [2] Gharib H, Papini E, Valcavi R, et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules[J]. Endocr Pract, 2006, 12:63-102. http://www.ncbi.nlm.nih.gov/pubmed/16596732
    [3] Eng CY, Quraishi MS, Bradley PJ. Management of thyroid nodules in adult patients[J]. Head Neck Oncol, 2010, 2:11. doi:  10.1186/1758-3284-2-11
    [4] Bomeli SR, LeBeau SO, Ferris RL. Evaluation of a thyroid nodule[J]. Otolaryngol Clin North Am, 2010, 43:229-238. doi:  10.1016/j.otc.2010.01.002
    [5] Yoon JH, Kwak JY, Moon HJ, et al. The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy and the sonographic differences between benign and malignant thyroid nodules 3 cm or larger[J]. Thyroid, 2011, 21:993-1000. doi:  10.1089/thy.2010.0458
    [6] Laucirica R, Bentz JS, Souers RJ, et al. Do liquid-based preparations of urinary cytology perform differently than classically prepared cases? Observations from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology[J]. Arch Pathol Lab Med, 2010, 134:19-22. http://www.ncbi.nlm.nih.gov/pubmed/20073599/
    [7] Hou G, Yin Y, Wang W, et al. Clinical impact of liquid-based cytology test on diagnostic yields from transbronchial needle aspiration[J]. Respirology, 2012, 17:1225-1228. doi:  10.1111/j.1440-1843.2012.02246.x
    [8] Sakakibara E, Kimachi S, Hashimoto K, et al. An aspiration material preparation system:application of a new liquid-based cytology technique for fine-needle aspiration of the breast[J]. Acta Cytol, 2011, 55:92-99. doi:  10.1159/000320857
    [9] Parfitt JR, McLachlin CM, Weir MM. Comparison of ThinPrep and conventional smears in salivary gland fine-needle aspiration biopsies[J]. Cancer, 2007, 111:123-129. doi:  10.1002/cncr.22575
    [10] McKee G. The role of fine needle aspiration cytology in the diagnosis of thyroid lesions[J]. J R Soc Med, 1998, 91:28-32. doi:  10.1177/014107689809133S07
    [11] Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid:an appraisal[J]. Ann Intern Med, 1993, 118:282-289. doi:  10.7326/0003-4819-118-4-199302150-00007
    [12] Cochand-Priollet B, Guillausseau PJ, Chagnon S, et al. The diagnostic value of fine needle aspiration biopsy under ultrasonography in nonfunctional thyroid nodules:a prospective study comparing cytologic and histologic findings[J]. Am J Med, 1994, 97:152-157. doi:  10.1016/0002-9343(94)90025-6
    [13] Malle D, Valeri RM, Pazaitou-Panajiotou K, et al. Use of a thin-layer technique in thyroid fine needle aspiration[J]. Acta Cytol, 2006, 50:23-27. doi:  10.1159/000325890
    [14] Frost AR, Sidawy MK, Ferfelli M, et al. Utility of thin-layer preparations in thyroid fine-needle aspiration:diagnostic accuracy, cytomorphology, and optimal sample preparation[J]. Cancer, 1998, 84:17-25. doi:  10.1002/(SICI)1097-0142(19980225)84:1<17::AID-CNCR4>3.0.CO;2-C
    [15] Saleh HA, Hammoud J, Zakaria R, et al. Comparison of Thin-Prep and cell block preparation for the evaluation of thyroid epithelial lesions on fine needle aspiration biopsy[J]. Cytojournal, 2008, 5:3. doi:  10.1186/1742-6413-5-3
    [16] Michael CW, Pang Y, Pu RT, et al. Cellular adequacy for thyroid aspirates prepared by ThinPrep:how many cells are needed?[J]. Diagn Cytopathol, 2007, 35:792-797. doi:  10.1002/dc.20768
    [17] Hasteh F, Pang Y, Pu R, et al. Do we need more than one ThinPrep to obtain adequate cellularity in fine needle aspiration?[J]. Diagn Cytopathol, 2007, 35:740-743. doi:  10.1002/dc.20735
    [18] Fadda G, Rossi ED, Raffaelli M, et al. Fine-needle aspiration biopsy of thyroid lesions processed by thin-layer cytology:one-year institutional experience with histologic correlation[J].Thyroid, 2006, 16:975-981. doi:  10.1089/thy.2006.16.975
    [19] Stamataki M, Anninos D, Brountzos E, et al. The role of liquid-based cytology in the investigation of thyroid lesions[J]. Cytopathology, 2008, 19:11-18. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=b11fb0fac4167a17498f12b65a91bfa4
    [20] Witt RL. A comparison of the results of monolayer versus smear cytopreparatory techniques for fine-needle aspiration in 100 consecutive patients undergoing thyroidectomy:a surgeon's perspective[J]. Otolaryngol Head Neck Surg, 2004, 131:964-967. doi:  10.1016/j.otohns.2004.07.004
    [21] Cochand-Priollet B, Prat JJ, Polivka M, et al. Thyroid fine needle aspiration:the morphological features on ThinPrep slide preparations. Eighty cases with histological control[J]. Cytopathology, 2003, 14:343-349. doi:  10.1046/j.0956-5507.2003.00098.x
    [22] Afify AM, Liu J, Al-Khafaji BM. Cytologic artifacts and pitfalls of thyroid fine-needle aspiration using ThinPrep:a comparative retrospective review[J]. Cancer, 2001, 93:179-186. doi:  10.1002/cncr.9027
    [23] Zhang Y, Fraser JL, Wang HH. Morphologic predictors of papillary carcinoma on fine-needle aspiration of thyroid with ThinPrep preparations[J]. Diagn Cytopathol, 2001, 24:378-383. doi:  10.1002/dc.1084
    [24] MacDonald L, Yazdi HM. Fine needle aspiration biopsy of Hashimoto's thyroiditis. Sources of diagnostic error[J]. Acta Cytol, 1999, 43:400-406. doi:  10.1159/000331088
    [25] Rossi ED, Raffaelli M, Minimo C, et al. Immunocytochemical evaluation of thyroid neoplasms on thin-layer smears from fine-needle aspiration biopsies[J]. Cancer, 2005, 105:87-95. doi:  10.1002/cncr.21026
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  • 收稿日期:  2013-10-31
  • 刊出日期:  2014-01-30

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