摘要
目的评估短轴穿刺和长轴穿刺两种方法对甲状腺结节超声引导细针穿刺抽吸活体组织检查（USFNAB）结果的影响。方法回顾性分析2011年3月—2014年11月行US-FNAB的甲状腺结节患者共2 686例的临床资料。US-FNAB由5名初学者（Dr1-Dr5）进行操作,其中Dr1-Dr4每名初学者穿刺结节均为571例,Dr5为402例。根据Bethesda分类标准将细胞学结果分为穿刺有效和穿刺无效两类。Dr2是短轴穿刺,Dr1、Dr3-Dr5是长轴穿刺。按照甲状腺结节穿刺时间的先后顺序,分别比较Dr2与Dr1、Dr3-Dr5间第1个200例（F200）及最后1个200例（L200）穿刺无效率的差异（检验水准α=0.05）,再分别进行Dr1、Dr3-Dr5间F200及L200穿刺无效率的两两比较（检验水准α’=0.008）。结果在F200例的比较中：Dr2的穿刺无效率高于Dr1、Dr3-Dr5,且差异均有统计学意义（P值分别为0.036、〈0.001、0.007及〈0.001）;Dr1、Dr3-Dr5穿刺无效率的两两比较差异均无统计学意义（P值分别为0.033、0.551、0.011、0.122、0.672、0.050）。在L200的比较中：Dr2的穿刺无效率低于Dr4,而高于Dr5,差异有统计意义学（P=0.027,0.003）;Dr1、Dr3-Dr5穿刺无效率的两两比较,仅Dr3和Dr5、Dr4和Dr5间差异有统计学意义（P值分别为0.005,〈0.001）。结论对初学者而言,长轴穿刺方法优于短轴穿刺方法,建议初学者学习长轴穿刺方法。穿刺病例量达到200例后,长轴和短轴两种穿刺方法对穿刺结果的影响不明显,穿刺操作者可根据病变情况和个人爱好等选择穿刺方法。
Objective To assess the effect of short-axis and long-axis punctures of thyroid nodules on the diagnostic rate of ultrasound guided aspiration biopsy（US-FNAB）. Methods We retrospectively analyzed the clinical data of 2 686 thyroid nodule patients who underwent US-FNAB between March 2011 and November 2014. The USFNAB was performed by 5 beginners（571 each for Dr1-Dr4 and 402 for Dr5）. Yields of US-FNAB were divided into two levels according to the classification standard of the Bethesda system： adequacy and inadequacy. Short-axis puncture technique was used by Dr2 and long-axis puncture was performed by the others. According to chronological sequence of thyroid nodules examined, we compared the inadequate diagnostic rate between Dr2 and the others for the first 200 cases and the last 200 cases, respectively. The inadequate diagnostic rate was compared among the 4 doctors who used longaxis punctures for the first 200 cases and the last 200 cases, respectively. Results The inadequacy rate of US-FNAB for Dr2 was higher than that for Dr1, Dr3, Dr4 and Dr5 in the first 200 cases, with statistical significance（P=0.036, 0.001, =0.007 and 0.001, respectively）. There was no significant difference in inadequate diagnostic rate among the 4 doctors who used long-axis punctures for the first 200 cases（P=0.033, 0.551, 〈0.011, 0.122, 0.672 and 0.050）. The inadequacy rate of US-FNAB for Dr2 was higher than that for Dr5 and lower than that for Dr4 in the last 200 cases with statisticalsignificance（P=0.027 and 0.003, respectively）. The inadequacy rate of US-FNAB for Dr5 was lower than that for Dr3（P=0.005） and Dr4（P〈 0.001） among the 4 doctors who used long-axis punctures for the last 200 cases. Conclusions For beginners, the inadequacy rate of short-axis puncture is higher than long-axis puncture. We suggest beginners learn long-axis puncture method. There is no significant difference in inadequate diagnostic rate among short-axis and long-axis punctures, when the number of operated cases reaches 2
出处
《华西医学》
CAS
2015年第11期2094-2097,共4页
West China Medical Journal
