系统活检联合超声造影及弹性成像靶向活检在前列腺活检中的应用价值

摘要 目的：探讨系统活检联合超声造影及弹性成像靶向活检在前列腺活检中的应用价值。方法：回顾性分析2015年1月至2019年12月我院收治的394例可疑前列腺癌患者的临床资料。分为前期组（2015年1月至2017年4月,采用12针系统活检法,共186例）,和近期组（2017年5月至2019年12月,采用8针系统活检联合新技术（超声造影及弹性成像）靶向活检法,共208例）。前期组行12+X针系统穿刺活检。近期组患者先行彩虹灌注及实时弹性成像检查,确定可疑区域后,于该区域行靶向穿刺活检,然后行8针系统穿刺活检,有重复区域者适当减少穿刺针数。结果：近期组阳性患者99例;前期组阳性患者63例,前列腺癌检出率分别为47.6%（99/208）、33.87%（63/186）,差异具有统计学意义（P<0.05）;近期组与前期组总穿刺针数分别为1929、2200针,近期组平均9.0 1.8针,前期组平均11.8 1.6针,差异具有统计学意义（P<0.05）;近期组与前期组穿刺针数阳性率分别为23.89%（461/1929）、11.82%（260/2200）,差异具有统计学意义（P<0.05）;近期组与前期组并发症发生率分别为27.40%（57/208）、43.01%（80/186）,差异具有统计学意义（P<0.05）。结论：系统活检联合超声造影及弹性成像靶向活检对前列腺癌具有较高应用价值。     

穿刺单针阳性前列腺癌的术后病理特征分析

摘要 目的：回顾性分析单针阳性患者的术后病理特征及Gleason评分的变化情况。方法：收集2018年9月-2020年6月在本院泌尿外科行穿刺活检,病理诊断为单针阳性的86例前列腺癌患者展开研究,按患者年龄、手术前PSA检测值、Gleason评分、临床分期（cTNM）进行分组,其中：年龄组（年龄≥70岁、年龄＜70岁）、术前PSA组（PSA＜10 ng/mL、≥10 ng/mL）、术前Gleason评分组（6分、3+4=7分、4+3=7分、≥8分）、临床分期组（cT1期组、cT2期组）。所有患者均采用腹腔镜下前列腺癌根治术和单针穿刺活检,观察纳入患者的基线资料,比较分析不同组别患者术后病理特征的差异和临床意义。结果：不同年龄患者病理特征无差异,PSA≥10 ng/mL组Gleason评分≥7分和Gleason评分升级患者占比显著高于PSA＜10 ng/mL组（P＜0.05）;cT2期组占比较低（P＜0.05）;cT2期组患者Gleason评分≥7分患者占比显著高于cT1期组（P＜0.05）,但两组切缘阳性和Gleason评分升级相比无统计学意义（P＞0.05）;不同Gleason评分患者术后pT0、切缘阳性、Gleason评分升级差异无统计学意义（P＞0.05）;不同Gleason评分患者术后病理分期差异有统计学意义,Gleason评分为4+3=7分患者病理分期＞2显著高于6分、3+4=7分和≥8分（P＜0.05）;Logistic回归分析结果显示,年龄＞70岁、PSA≥10 ng/mL、cT2期和Gleason评分≥7分是影响术后病理特征的主要危险因素（P＜0.05）。结论：前列腺单针阳性患者存在Gleason评分术后升高情况,部分患者伴有切缘阳性、病理分期≥T2特征,所以临床中无法将穿刺单针阳性作为前列腺癌患者低风险检测指标,需要结合患者其它各项指标对其进行个体化治疗方案。     

揿针联合蓝芩口服液治疗小儿急性扁桃体炎疗效及安全性

摘要 目的：探讨揿针联合蓝芩口服液治疗小儿急性扁桃体炎疗效及安全性。方法：选取2018年6月至2019年12月江苏省第二中医院收治的96例急性扁桃体炎患儿,随机将其分为两组,对照组48例,给予蓝芩口服液治疗,研究组48例,给予揿针联合蓝芩口服液治疗。观察两组患儿的临床疗效、临床症状改善时间、治疗前后WBC、CRP、NEU水平以及不良反应率。结果：研究组总有效率显著高于对照组(97.92 % vs.83.88 %,P＜0.05);研究组咽痛消失时间、扁桃体肿大消失时间、发热消失时间明显优于对照组(P＜0.05);两组患儿治疗前WBC、CRP、NEU水平指标比较（P>0.05）;治疗后WBC、CRP、NEU水平指标比较（P<0.05）。研究组不良反应率显著低于对照组(2.08 % vs.16.67 %,P＜0.05)。结论：揿针联合蓝芩口服液治疗小儿急性扁桃体炎疗效显著,能有效的降低临床症状消失时间,控制炎症,减少不良反应发生率,安全可靠,值得临床推广和应用。     

声触诊组织定量成像联合声诺维超声造影对乳腺BI-RADS 4类结节的鉴别诊断价值

摘要 目的：探讨声触诊组织定量成像（VTIQ）联合声诺维超声造影对乳腺BI-RADS 4类结节的鉴别诊断价值。方法：将我院2018年6月至2019年12月门诊及住院诊治的90例女性乳腺结节患者作为研究对象,利用VTIQ超声弹性成像技术,获取剪切波速度最大值（SWVmax）、剪切波速度最小值（SWVmin）、剪切波速度平均值（SWVmean）,声诺维超声造影评估病灶回声、形态、血管充盈情况。以手术病理或超声引导穿刺活检病理结果作为金标准,分析VTIQ超声弹性成像联合声诺维超声造影对乳腺BI-RADS 4类结节的鉴别诊断价值。结果：90例患者（90个乳腺结节）中,经手术病理检查62例,经超声引导穿刺活检28例,其中良性结节48例,恶性结节42例。乳腺BI-RADS 4类良性及恶性结节的SWVmax、SWVmin及SWVmean比较有统计学差异（P<0.05）;以SWVmax≥3.83 m/s作为截断点,鉴别诊断乳腺BI-RADS 4类良恶性结节的曲线下面积（AUC）、敏感度、特异度分别为0.875、83.33%、91.67%,均高于SWVmin及SWVmean。SWVmax、声诺维超声造影与联合诊断的准确率比较无统计学差异（P>0.05）。SWVmax联合声诺维超声造影检查在鉴别诊断乳腺BI-RADS 4类良恶性结节的AUC、敏感度、特异度分别为0.914、95.24%、87.50%,诊断效能最佳。结论：声诺维超声造影、VTIQ超声弹性成像在乳腺BI-RADS 4类结节鉴别诊断中有一定的价值,VTIQ超声弹性成像的SWVmax参数诊断效能优于SWVmin及SWVmean,VTIQ超声弹性成像联合声诺维超声造影可提升乳腺BI-RADS 4类结节鉴别诊断效能。     

小儿与成人静脉留置针穿刺的护理成本比较与分析

目的 了解目前小儿与成人手术患者静脉留置针穿刺的护理成本投入。方法 根据项目综合评估和核算方法,分别核算小儿与成人静脉留置针穿刺的护理成本投入情况。结果 小儿与成人静脉留置针穿刺操作的平均护理成本已分别达到77.84元和25.62元,与现行收费标准存在巨大差异,小儿静脉留置针穿刺的护理成本远远高于成人。结论 全面客观地核算了静脉留置针穿刺的护理成本投入,为体现护理技术的价值提供了准确的依据。     

超声多技术联合在良恶性甲状腺结节鉴别诊断中的应用价值

摘要 目的：分析超声剪切波弹性成像（SWE）、超声造影（CEUS）、声触诊组织成像及定量（VTIQ）、促甲状腺激素（TSH）多技术联合在甲状腺结节良恶性鉴别诊断中的应用价值。方法：选取宁德市医院甲状腺不确定性质结节患者120例,以病理结果为金标准将其分为良性组和恶性组,分析两组SWE、CEUS、VTIQ各影像参数及术前TSH水平差异,绘制受试者工作特征曲线（ROC）评估上述技术联合对甲状腺结节良恶性的鉴别诊断价值。结果：120例患者共检出128个结节,其中良性47个,恶性81个;恶性组SWE中弹性模量值（Emax、Emin、Emean）均大于良性组（P＜0.01）;恶性组、良性组在CEUS中强化差异有显著性（P＜0.05）;VTIQ中恶性组剪切波速度（SWV）最大值、最小值、平均值均大于良性组（P＜0.01）;恶性组患者术前TSH水平高于良性组（P＜0.01）;ROC曲线分析显示,SWE、CEUS、VTIQ、TSH联合检测诊断甲状腺结节良恶性的效能最高,其灵敏度、特异度、准确度、曲线下面积（AUC）分别为85.19%、89.36%、86.72%、0.873。结论：SWE、CEUS、VTIQ、TSH联合对区分甲状腺结节良恶性有较高价值。     

胸部CT结合AI诊断系统对疑似肺结节患者的诊断及对结节类型的评估价值

摘要 目的：探讨胸部CT结合AI诊断系统对疑似肺结节患者的诊断及对结节类型的评估价值。方法：选取2019年12月-2020年12月在我院进行CT检查的358例疑似肺结节患者,将其按照随机数字表法分为两组：对照组（放射科医生根据CT扫描结果,通过人工阅片分析记录检出结节数量和影像特征）,观察组（将CT扫描结果导入AI辅助诊断系统,经AI运算得到结节检出数量和影像特征）。AI辅助系统IMsight用于肺结节的图像分析和自动检测。通过组织病理学确定结节的良恶性。绘制受试者工作特征曲线（ROC）曲线以评估AI和CT结合图像的诊断价值。结果：病理结果最后确诊结节数量736个,恶性结节139个（18.89 %）,良性结节597个（81.11 %）。观察组诊断结节数量717个,检出率97.42%,对照组诊断出结节数量603个,检出率81.93 %。观察组较对照组的结节检出率、阳性检出率升高（P<0.05）,漏检率和假阴性率均显著降低（P<0.05）。当结节小于10 mm时,观察组较对照组的检出率升高（P<0.05）,观察组较对照组对磨玻璃密度结节和实性结节检出率升高（P<0.05）,观察组较对照组位于胸膜结节检出率升高（P<0.05）。观察组较对照组AUC（P<0.05）,表明AI系统下的结节检出准确率高。ROC曲线显示观察组的敏感性和特异性分别为88.39%和89.68 %,对照组的敏感性和特异性分别为75.24 %和82.34 %,观察组较对照组的ROC曲线敏感性和特异性升高（P<0.05）。结论：AI辅助诊断系统可有效提高肺结节的检出率,减少误检率及漏检率,值得在肺结节CT检测中应用推广。     

浮针埋线联合推拿疗法对神经根型颈椎病疗效及对颈椎活动度、生理曲度变化的影响

摘要 目的：探讨与分析浮针埋线联合推拿疗法对神经根型颈椎病疗效及对颈椎活动度、生理曲度变化的影响。方法：2019年2月到2021年6月选择在本院诊治的神经根型颈椎病患者105例作为研究对象,根据1：1简单分配原则把患者分为浮针组53例与对照组52例。对照组给予推拿治疗,浮针组在对照组治疗的基础上给予浮针埋线治疗,两组都治疗观察21 d,记录患者颈椎活动度、生理曲度变化情况。结果：治疗后浮针组的总有效率为98.1 %,与对照组的86.5 %相比有明显提高（P<0.05）。浮针组与对照组治疗后的颈椎活动度评分明显低于治疗前,浮针组与对照组相比也明显降低（P<0.05）。浮针组与对照组治疗后的疼痛视觉模拟评分法（VAS）评分明显低于治疗前,颈椎日本骨科协会评估治疗分数（JOA）评分明显高于治疗前,治疗后浮针组与对照组对比也有明显差异（P<0.05）。浮针组与对照组治疗后的颈椎生理曲度明显高于治疗前,浮针组也明显高于对照组（P<0.05）。结论：浮针埋线联合推拿疗法在神经根型颈椎病患者的应用能促进缓解疼痛,改善颈椎功能,能提高治疗疗效,改善患者的颈椎活动度,还可促进颈椎生理曲度恢复正常。     

低剂量与常规剂量扫描在CT引导下经皮穿刺肺活检术中的临床应用价值对比研究

摘要 目的：比较低剂量与常规剂量扫描在CT引导下经皮穿刺肺活检术中的临床应用价值。方法：选择2018年1月至2019年12月我院行CT引导下经皮穿刺肺活检术的患者96例,采用随机数字表法分为低剂量组和常规剂量组,每组48例,两组分别在低剂量扫描、常规剂扫描下行CT引导下经皮穿刺肺活检术,比较两组扫描范围、X射线剂量、图像质量、穿刺成功率及并发症发生情况。结果：低剂量组CT吸收剂量加权指数（CTDIw）、平均剂量长度乘积（DLP）显著低于常规剂量组（P<0.05）,两组扫描范围比较无统计学差异（P>0.05）。低剂量组图像质量1级1例、2级1例、3级46例;常规剂量组1级0例、2级1例、3级47例,两组图像质量比较无统计学差异（P>0.05）。低剂量组穿刺成功率87.50%,常规剂量组穿刺成功率89.58%,两组穿刺成功率比较无统计学差异（P>0.05）。低剂量组并发症发生率为12.50%,常规剂量组并发症发生率为10.42%,两组并发症发生率比较差异无统计学意义（P>0.05）。结论：与常规剂量扫描相比,在CT引导下经皮穿刺肺活检术中应用低剂量扫描可以有效降低辐射剂量,但不影响图像质量和穿刺成功率,患者并发症发生率也未增加,具有较好的临床价值。     

B 超引导下甲状腺肿块细针穿刺细胞学诊断的临床病理分析

摘要目的：比较B 超引导下细针吸取穿刺和传统细针吸取穿刺在甲状腺肿块性质确定中意义。方法：使用B 超引导下细针吸取 穿刺（UG-FNAB）和传统细针吸取穿刺技术（c-FNAB）对225 例甲状腺肿块进行穿刺活检，然后进行涂片，染色，镜检，结合临床作 出细胞学诊断，并与组织切片诊断对照，比较两种方法的确诊率。结果：在UG-FNAB 检测病例中59.3%的结节位于甲状腺右叶， 40.7%肿块位于左叶和峡部。87%的患者甲状腺机能正常，结节最长径平均为2.8± 1.1 cm，部分病例符合甲状腺恶性肿瘤的超声 影像学改变。在本研究中诊断为甲状腺乳头状癌的病例细胞学和组织学特点均符合甲状腺癌形态学特点。在225 例研究病例中， 总确诊率为72.89%（164/225），其中UG-FNAB组确诊率为90.58%（77/85），C-FNAB 组确诊率为62.14%(87/140) ,两组确诊率比 较有显著性差异（P<0.05）。结论：本组研究数据显示比较C-FNAB，UG-FNAB在诊断甲状腺复杂性结节中具有更高的确诊率，特 别是在C-FNAB方法不能得出明确诊断时。     

Comparison of the Efficacy and Safety of Ultrasound-Guided Core Needle Biopsy Versus Fine-Needle Aspiration for Evaluating Thyroid Nodules

ObjectiveUltrasound-guided core needle biopsy (UG-CNB) is a procedure that is often performed either after repeated inadequate or nondiagnostic ultrasound-guided fine-needle aspiration (UG-FNA) or in combination with UG-FNA in the evaluation of thyroid nodules. The purpose of this study was to compare the efficacy and safety of UG-CNB and UG-FNA for evaluating thyroid nodules.MethodsThis was a retrospective study of 350 consecutive patients who had thyroid nodules biopsied by UG-CNB or UG-FNA from January 2007 until November 2011 at our institution. Biopsy results were compared to the surgical specimen pathology reports for the 105 patients who subsequently underwent hemi- or total thyroidectomy in order to determine whether UG-CNB has advantages over UG-FNA for diagnosing thyroid malignancy and neoplasia.ResultsOut of 461 thyroid nodules biopsied from 350 patients, 365 (79%) involved UG-CNB and 96 (21%) involved UG-FNA. The UG-FNA biopsy group had a significantly higher rate of inadequate sampling than the UG-CNB group (P < .0001; Fisher’s exact test). Out of 365 UG-CNB samples, 6 (2%) were deemed inadequate for histologic diagnosis, whereas 26 (27%) of the 96 UG-FNA samples were considered inadequate for cellularity. Comparison of biopsy results with the surgical specimen pathology reports revealed that the diagnostic accuracy of UG-CNB and UG-FNA for detecting malignancy was similar, at 89 and 94%, respectively (not significant by Fisher’s exact test). However, the UG-CNB group had a higher detection rate for benign follicular lesions compared to the UG-FNA group (65% versus 48% for UG-FNA; P = .002). Although UG-FNA detected neoplasia with high sensitivity (100%), the specificity was poor (30%). Neither biopsy group had any significant immediate or delayed procedure-related complications.ConclusionOur study demonstrated that UG-CNB is safe and is less likely to result in a nondiagnostic biopsy. The accuracy of the UG-CNB technique is similar to that of UG-FNA for detecting thyroid malignancy. (Endocr Pract. 2015;21:128-135)     

Diagnostic Accuracy of CT-Guided Transthoracic Needle Biopsy for Solitary Pulmonary Nodules

To evaluate the diagnostic accuracy of computed tomography (CT)-guided percutaneous lung biopsy for solitary pulmonary nodules. Three hundred and eleven patients (211 males and 100 females), with a mean age of 59.6 years (range, 19–87 years), who were diagnosed with solitary pulmonary nodules and underwent CT-guided percutaneous transthoracic needle biopsy between January 2008 and January 2014 were reviewed. All patients were confirmed by surgery or the clinical course. The overall diagnostic accuracy and incidence of complications were calculated, and the factors influencing these were statistically evaluated and compared. Specimens were successfully obtained from all 311 patients. A total of 217 and 94 cases were found to be malignant and benign lesions, respectively, by biopsy. Two hundred and twenty-five (72.3%) carcinomas, 78 (25.1%) benign lesions, and 8 (2.6%) inconclusive lesions were confirmed by surgery and the clinical course. The diagnostic accuracy, sensitivity, and specificity of CT-guided percutaneous transthoracic needle biopsy were 92.9%, 95.3%, and 95.7%, respectively. The incidences of pneumothorax and self-limiting bleeding were 17.7% and 11.6%, respectively. Taking account of all evidence, CT-guided percutaneous lung biopsy for solitary pulmonary nodules is an efficient, and safe diagnostic method associated with few complications.     

Follow‐up of atypia and follicular lesions of undetermined significance in thyroid fine needle aspiration cytology

N. Dincer, S. Balci, A. Yazgan, G. Guney, R. Ersoy, B. Cakir and G. Guler
Follow‐up of atypia and follicular lesions of undetermined significance in thyroid fine needle aspiration cytology Objective: To report our experience of atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) rate and outcome. Methods: Among 7658 patients with 19 569 nodules, 524 (2.7%) nodules were diagnosed as AUS/FLUS on fine needle aspiration (FNA). After exclusion of patients with simultaneous nodules that were suspicious for follicular neoplasm or malignancy or that were malignant, 368 (4.8%) patients were diagnosed as AUS/FLUS. The outcome of 146 patients who had undergone surgery or repeated fine needle aspirate at the time of preparation of this study was evaluated. The original FNAs were matched to repeated FNAs and thyroidectomy or diagnostic lobectomy specimens. Results: Seventy‐two (19.6%) of the 368 patients had directly undergone surgery, either a lobectomy or a thyroidectomy: of these, 27 (37.5%) had neoplastic nodules (21 were malignant). Seventy‐four (20.1%) of the 368 patients had repeat FNA. On second FNA, 47 of 74 (63.5%) were benign, three were suspicious for follicular neoplasm, one was malignant and 23 (31.1%) were non‐diagnostic. Four patients had a third FNA: two were AUS/FLUS, one was malignant and one non‐diagnostic. One patient had a fourth FNA, which was diagnosed as AUS/FLUS. Sixteen (21.6%) of 74 patients with repeat FNA had surgery: three of these had neoplastic nodules (two were malignant). Overall, 88 of the 368 (23.9%) patients had a thyroidectomy of which 30 (34.1%) were neoplastic and 23 (26.1%) malignant. The neoplastic rate for patients who were once diagnosed with AUS/FLUS was 8.2% and the malignancy rate 6.3%. The malignancy rate for patients on follow‐up at the time we prepared the study was 15.7% (23/146); 222 remained on follow‐up without surgery or repeat FNA or were managed elsewhere. Conclusions: Although in this category repeat FNA is expected rather than excision, we suggest evaluation of all AUS/FLUS patients in multidisciplinary meetings to decide management and recommend follow‐up of all patients with this diagnosis.     

甲状腺良、恶性结节的临床、超声及细胞学特征分析

目的:研究良、恶性甲状腺结节的相关临床因素、超声特征与甲状腺细针穿刺细胞学检查结果之间的关系。方法:收集2010年1月至2013年12月在上海市第一人民医院因甲状腺结节就诊,并进行超声引导下FNAB检查患者的临床资料,以FNAB细胞学诊断结果为诊断标准,分析和比较不同性质甲状腺结节患者的年龄、性别、甲状腺疾病家族史、临床症状、血清甲状腺激素、甲状腺自身抗体(TPOAb和TRAb)水平,超声检查所发现的结节数量、性状、前后径与横径比(AP/TR)、回声类型、钙化类型、边界状态、血流情况等因素,采用Logistic多因素回归,探讨这些临床和超声特征与甲状腺良、恶性结节之间的关系。结果:根据FNAB结果,1592例患者中,良性结节者1492例,恶性结节者77例,结果不确定者23例。以良性组作为对照,年龄40岁、TPOAb(+)是恶性甲状腺结节的独立危险因素(P0.05);出现钙化点、细小钙化斑、边界不规整的超声表现的恶性甲状腺的风险显著升高(P0.05)。结论:超声检查甲状腺结节出现钙化点、细小钙化斑或边界不规整等与FNAB诊断的甲状腺恶性结节之间存在明显的关联。     

B超引导下乳腺肿块粗针穿刺诊断的分析（附120例报道）

目的：探讨B超引导下粗针穿刺在乳腺肿块诊断中的应用意义。方法：使用B超引导下粗针吸取穿刺对120例乳腺肿块进行穿刺活检,然后进行固定,脱水,染色,镜检,结合临床作出病理学诊断。结果：粗针穿刺诊断包括良性病变48例,非典型性导管上皮增生（ADH）32例,导管内癌12例,浸润性癌28例。与后续手术标本病理诊断比较得出确诊率,其中良性病变的诊断率为95．83％（46／48）,ADH的确诊率为75％（24／32）,导管内癌的确诊率为58．33％（7／12）,浸润性癌诊断率为92．86％（26／28）,其中导管内癌与浸润性导管癌和乳腺良性病变的确诊率有显著性差异,而ADH与浸润性导管癌和乳腺良性病变间的确诊率有差异,但本组数据没有统计学意义。结论：超声引导下粗针穿刺对乳腺浸润性癌和良性病变的诊断率较高,但对ADH和原位癌的确诊率较低,有待进一步改进。     

A Literature Review of Factors Associated With Pain From Fine Needle Aspiration Biopsy of Thyroid Nodules

ObjectiveThyroid nodules are common, being detected in 19% to 67% of the population. A fine needle aspiration biopsy (FNAB) is recommended for suspicious thyroid nodules to rule out malignancy; however, the procedure can be painful for subsets of patients. It remains unclear what factors are more likely to be associated with pain during FNAB. This literature review aimed to investigate patient-, procedure-, and analgesic-related factors that affect pain levels during thyroid nodule FNAB.MethodsPredefined inclusion and exclusion criteria were set to search the Embase, MEDLINE, CINAHL, and Cochrane databases. The articles evaluating the factors affecting pain during FNAB were assessed for inclusion. The primary outcome of interest was scores evaluating pain level during FNAB.ResultsTwenty-two studies were included. The studies were a mix of cohort studies, randomized controlled trials, and clinical controlled trials. Under patient-related factor, nodule calcification was associated with increasing pain. The procedure-related factors potentially increasing pain included the number of needle passes and utilization of the aspiration technique (as opposed to capillary action), perpendicular needle placement (as opposed to parallel), and not using safety devices. Larger needle size, type of biopsy, operator expertise, and patient education did not appear to be correlated with pain. Subcutaneous lidocaine appeared to provide better pain relief than a topical analgesic.ConclusionWith increasing use of FNAB as the diagnostic test of choice for assessing thyroid nodules, understanding patient-, procedure-, and analgesic-related factors associated with optimal patient satisfaction is imperative.     

Comparison of Fine Needle Sampling By Capillary Action and Fine Needle Aspiration

Fine needle aspiration (FNA) and non-suction fine needle sampling (FNS) were performed consecutively in 107 lesions from 100 patients. the quality of diagnostic material was assessed using a scoring system based on the cellularity and amount of blood in the smear. the total score in the FNS group was significantly higher (P < 0.05) than that of FNA technique. the FNS procedure is less traumatic and equally cost effective and can be safely undertaken in liver, orbital and thyroid lesions. In lymph nodes, especially in children, FNS gives an excellent cellular yield. However, this procedure can not be advocated in cystic, bony and fibrous lesions.     

Thyroid Nodules with 2 Prior Inadequate Fine-Needle Aspiration Results: Effect of Increasing the Diameter of the Needle

Objective: The major limitation of ultrasound-guided fine-needle aspiration biopsy (US-FNAB) procedures of thyroid nodules are the cytologically nondiagnostic results. The role of increasing the diameter of the needle in the third FNAB (FNAB#3) due to inadequate cytology has as yet not been investigated. The aim of the present study was to evaluate whether increasing the needle diameter could improve the cytologic sampling of thyroid nodules following 2 previous nondiagnostic US-FNAB results.Methods: Between July 2012 and December 2012, 140 consecutive patients with 2 prior nondiagnostic US-FNAB results were enrolled in this prospective investigation. Group 22G consisted of 70 patients (78.5% women; mean age, 52 years) having nodules examined with a 22-gauge (G) needle. Group 27G consisted of 70 patients (75.7% women; mean age, 53 years) having nodules examined with a 27-G needle.Results: The rate of nondiagnostic FNAB results was 42.8% (30 of 70) in group 22G and 64.3% (45 of 70) in group 27G, which was a significant difference (P = .011). The large-bore (22 G) needle was found to be statistically significantly superior compared with the small-bore (27 G) needle in diagnostic ability for predominantly solid (P = .014), irregular (P = .013), and halo-free (P = .021) nodules. The accuracy rate was 64.6 and 38% for large-bore (22 G) and small-bore (27 G) needles, respectively.Conclusion: The results of our study showed that increasing the needle lumen diameter significantly improves diagnostic performance in terms of adequate aspirated material and diagnostic accuracy rate following 2 prior nondiagnostic US-FNABs.Abbreviations: AUS = atypia of undetermined significance FNAB = fine-needle aspiration biopsy G = gauge NPV = negative predictive value PPV = positive predictive value US = ultrasound     

Thyroid fine needle aspiration cytology processed by ThinPrep: an additional slide decreased the number of inadequate results

E. D. Rossi, F. Morassi, G. Santeusanio, G. F. Zannoni and G. Fadda
Thyroid fine needle aspiration cytology processed by ThinPrep: an additional slide decreased the number of inadequate results Background: Fine needle aspiration cytology is the most accurate tool for diagnosing thyroid nodules. Its accuracy is related to the rate of inadequate samples, which can be minimized with the adoption of on‐site assessment of the adequacy of the material. The introduction of liquid‐based cytology (LBC) in the thyroid does not allow checking on the adequacy of the cellularity. The possibility of making a second LBC slide for decreasing the number of non‐diagnostic cases is studied. Methods: Out of 553 cases diagnosed in a single institution from January to March 2005, 166 consecutive cases with an LBC slide reviewed by the same pathologist were evaluated. The cases were classified in a five‐tiered category system (Thy1 to 5 according to the British Thyroid Association guidelines) and all but two (with cystic degeneration) were processed by LBC and stained with Papanicolaou stain. The above‐mentioned categories are defined as follows: Thy1 inadequate or haemorrhagic, Thy2 non‐neoplastic lesion; Thy3 follicular lesion/suspected follicular neoplasm; Thy4 suspicious for malignancy; Thy5 diagnostic of malignancy. For each case the cytological diagnosis was made on the LBC slide and the adequacy of the cellularity for a conclusive diagnosis was assessed. Results: Of the 166 cases, 39 were non‐diagnostic (Thy1—inadequate), ten presented features of cystic degeneration (Thy1—haemorrhagic), 90 were benign (Thy2), 22 were diagnosed as a follicular lesion (Thy3), one as suspicious of malignancy (Thy4) and four as papillary carcinoma (Thy5). Thirty‐nine cases had a second LBC for achieving a definitive diagnosis with eventual re‐classification. Of these cases, 23 (61.5%) led to a conclusive diagnosis (18 Thy2, five Thy3) with a 18.5% decrease of the inadequacy rate. Conclusions: The making of an additional LBC slide helps in achieving a diagnosis in cases classified as non‐diagnostic on the first standard slide (52.1% recovery rate). This procedure is particularly helpful for meeting the adequacy criteria in benign and indeterminate lesions and could also be used for refining the diagnosis of suspicious for a malignant thyroid neoplasm.