超声引导下18针与20针穿刺活检对甲状腺结节的诊断效果比较

摘要 目的：比较超声引导下18针与20针穿刺活检对甲状腺结节的诊断效果。方法：选取我院超声科2018.8.6-2020.9.30共收治的167例甲状腺结节患者作为研究对象，将患者分为18针穿刺组（n=86）和20针穿刺组（n=81），分别对两组患者应用超声引导下18针和20针穿刺活检，比较不确定结果的发生率，包括非诊断性或异型性/滤泡性病变的未确定显著性，恶性肿瘤的诊断性能在最终诊断的结节中进行评估。比较两组并发症发生率及超声引导下的核心针穿刺活检标本产率。结果：对比20针穿刺组和18针穿刺组患者的临床特征发现，两组患者性别、年龄、结节大小、结节形状、方位、回声强度、表现和钙化情况对比无明显差异（P＜0.05）；在20针穿刺组中43个结节和18针穿刺组中46个结节最终确诊。恶性结节的比例在两组之间没有显著差异。在最终诊断分析中，20针穿刺组有38个结节，18针穿刺组中有40个结节。在20针穿刺组，38个结节包括6个非诊断结果、18个不典型/滤泡性病变（未确定显著性）和14个滤泡性肿瘤。在18针穿刺组中，40个结节包括1个非诊断结果，22个不典型/滤泡性病变未确定的显著性，17个滤泡性肿瘤；18针穿刺组的未确诊率（包括非诊断结果和未发现显著性的异型性/滤泡性病变）较低（29.1 % vs 37.0 %），尽管这一差异在统计学上没有显著性（P＞0.05）。然而，18针穿刺组的非诊断性结果发生率（1.2 % vs 8.6 %；P＜0.05）显著低于20针穿刺组。两组的不典型/滤泡性病变的发生率（27.8 % vs 28.4 %）相似。20针穿刺组的CNB显示出更高的敏感性（75.0 % vs 66.7 %），更高的阴性预测值（NPV；83.9 % vs 75.9 %）和更高的准确率（78.3 % vs 74.4 %），虽然结果没有达到统计显著性。两组的特异性（81.8 % vs 80.8 %）和阳性预测值（PPV；两者均为100 %）相似；18针穿刺组和20针穿刺组患者的并发症发生率对比无明显差异（P＞0.05）。结论：18针芯针活检对甲状腺结节的诊断较20针更有效，且不增加并发症情况，安全性好，值得临床应用推广。

Comparison of Ultrasound-guided 18 Needle and 20 Needle Biopsy in the Diagnosis of Thyroid Nodules

ABSTRACT Objective: To compare the diagnostic effect of ultrasound-guided 18 needle biopsy and 20 needle biopsy in thyroid nodules. Methods: A total of 167 patients with thyroid nodules admitted to the ultrasound department of our hospital from August 6, 2018 to September 30, 2020 were selected as the research objects. The patients were divided into 18 needle puncture group (n=86) and 20 needle puncture group(n=81) The diagnostic performance of malignant tumors was evaluated in the final diagnosis of nodules. The incidence of complications and the rate of ultrasound-guided core needle biopsy specimens were compared between the two groups. Results: Compared with the clinical characteristics of 20 needle puncture group and 18 needle puncture group, there was no significant difference in gender, age, nodule size, nodule shape, orientation, echo intensity, performance and calcification between the two groups(P<0.05); 43 nodules in the 20 needle puncture group and 46 nodules in the 18 needle puncture group were finally diagnosed. There was no significant difference in the proportion of malignant nodules between the two groups. In the final diagnosis analysis, there were 38 nodules in the 20 needle puncture group and 40 nodules in the 18 needle puncture group. In the 20 needle puncture group, 38 nodules included 6 non diagnostic results, 18 atypical / follicular lesions (undetermined significance) and 14 follicular tumors. In the 18 needle puncture group, 40 nodules included 1 non diagnostic result, 22 atypical / follicular lesions with undetermined significance and 17 follicular tumors; the rate of undiagnosed (including non diagnostic results and no significant atypia / follicular lesions) was lower in the 18 needle puncture group (29.1 % vs 37.0 %), although the difference was not statistically significant (P>0.05). However, the incidence of non diagnostic outcomes in the 18 needle puncture group(1.2 % vs. 8.6 %, P<0.05) was significantly lower than that in the 20 needle puncture group. The incidence of atypical / follicular lesions was similar between the two groups(27.8 % vs. 28.4 %). CNB in the 20 needle puncture group showed higher sensitivity (75.0 % vs. 66.7 %), higher negative predictive value (NPV; 83.9 % vs. 75.9 %) and higher accuracy (78.3 % vs. 74.4 %) for malignant tumors, although the results were not statistically significant. The specificity (81.8 % vs. 80.8 %) and positive predictive value (PPV; both were 100 %) were similar between the two groups; there was no significant difference in the incidence of complications between the 18 needle puncture group and the 20 needle puncture group(P>0.05). Conclusion: 18 needle biopsy is more effective than 20 needle in the diagnosis of thyroid nodules, and does not increase complications, good safety, worthy of clinical application and promotion.