超声弹性成像结合免疫组织化学染色对甲状腺细针穿刺2～3级病变结节的再分析
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摘要
目的探讨超声弹性成像结合免疫组织化学染色对超声引导下甲状腺细针穿刺细胞学(US-FNAC)结果为2～3级结节手术切除前进行分析的意义。方法回顾性分析2015年1月至2017年12月,甲状腺结节手术切除患者术前US-FNAC诊断结果,根据US-FNAC结果,对2～3级病变的结节应用超声弹性成像和免疫组织化学进行分析,并与术后组织病理结果进行对比,比较US-FNAC独立诊断与US-FNAC联合超声弹性成像和免疫组织化学对甲状腺2～3级结节良恶性判断的敏感度、特异度和准确性。结果 66例患者(70个结节)为2级病变,64例患者(64个结节)为3级病变。对2～3级甲状腺结节良恶性的判断,独立诊断与联合诊断的敏感度、特异度、阳性预测值、阴性预测值、诊断准确性分别为84.75%vs 91.53%(χ~2=1.297,P=0.255)、81.33%vs 92.00%(χ~2=3.692,P=0.055)、78.13%vs 90.00%(χ~2=3.228,P=0.072)、87.14%vs 93.24%(χ~2=1.525,P=0.217)、82.84%vs91.79%(χ~2=4.851,P=0.028),两者的诊断准确性差异有统计学意义。联合诊断与组织病理的一致性(Kappa=0.863,P<0.01)高于US-FNAC独立诊断(Kappa=0.711,P<0.01)。结论术前应用超声弹性成像和免疫组织化学分析能提高2～3级甲状腺结节病变的诊断准确性。
Objective To investigate the combination of elastic imaging(EI) and immunohistochemistry(IHC) for thyroid nodules with ultrasound guided fine needle aspiration cytology(US-FNAC) as grade 2 or 3 lesions. Methods The thyroid nodules were punctured with fine needle. According to the results of US-FNAC diagnosis, EI and IHC were used to analyze the nodule of grade 2 and grade 3 lesions before operation, and the results were compared with the pathological results after operation. The sensitivity, specificity and accuracy of independent US-FNAC and combined US-FNAC+EI+IHC diagnosis for benign and malignant thyroid nodules were compared. Results Retrospective analysis of preoperative FNA diagnosis in patients undergoing thyroidectomy showed 66 patients(70 nodules) with grade 2 lesions and 64 patients(64 nodules) with grade 3 lesions. The comparison of the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the diagnosis of benign and malignant thyroid nodules of grade 2 or 3 between US-FNAC and US-FNAC combined with EI and IHC were 84.75% vs 91.53%(χ~2=1.297, P=0.255), 81.33% vs 92.00%(χ~2=3.692, P=0.055), 78.13% vs 90.00%(χ~2=3.228, P=0.072), 87.14% vs93.24%(χ~2=1.525, P=0.217), 82.84% vs 91.79%(χ~2=4.851, P=0.028), respectively. The difference of accuracy between independent and combined diagnosis was statistically significant. The consistency betweencombined diagnosis and histopathology(Kappa=0.863, P<0.01) was higher than that between US-FNAC independent diagnosis and histopathology(Kappa=0.711, P<0.01). Conclusion The accuracy of diagnosis of thyroid nodule of grade 2-3 can be improved by using EI and IHC analysis before operation.
Objective To investigate the combination of elastic imaging(EI) and immunohistochemistry(IHC) for thyroid nodules with ultrasound guided fine needle aspiration cytology(US-FNAC) as grade 2 or 3 lesions. Methods The thyroid nodules were punctured with fine needle. According to the results of US-FNAC diagnosis, EI and IHC were used to analyze the nodule of grade 2 and grade 3 lesions before operation, and the results were compared with the pathological results after operation. The sensitivity, specificity and accuracy of independent US-FNAC and combined US-FNAC+EI+IHC diagnosis for benign and malignant thyroid nodules were compared. Results Retrospective analysis of preoperative FNA diagnosis in patients undergoing thyroidectomy showed 66 patients(70 nodules) with grade 2 lesions and 64 patients(64 nodules) with grade 3 lesions. The comparison of the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the diagnosis of benign and malignant thyroid nodules of grade 2 or 3 between US-FNAC and US-FNAC combined with EI and IHC were 84.75% vs 91.53%(χ~2=1.297, P=0.255), 81.33% vs 92.00%(χ~2=3.692, P=0.055), 78.13% vs 90.00%(χ~2=3.228, P=0.072), 87.14% vs93.24%(χ~2=1.525, P=0.217), 82.84% vs 91.79%(χ~2=4.851, P=0.028), respectively. The difference of accuracy between independent and combined diagnosis was statistically significant. The consistency betweencombined diagnosis and histopathology(Kappa=0.863, P<0.01) was higher than that between US-FNAC independent diagnosis and histopathology(Kappa=0.711, P<0.01). Conclusion The accuracy of diagnosis of thyroid nodule of grade 2-3 can be improved by using EI and IHC analysis before operation.
引文
[1]Mondal SK, Sinha S, Basak B, et al. The Bethesda system for reporting thyroid fine needle aspirates:A cytologic study with histologic follow-up[J]. J Cytol, 2013, 30(2):94-99.
[2]Nandedkar SS, Dixit M, Malukani K, et al. Evaluation of thyroid lesions by fine-needle aspiration cytology according to Bethesda system and its histopathological correlation[J]. Int J Appl Basic Med Res, 2018, 8(2):76-82.
[3]Alshaikh S, Harb Z, Aljufairi E, et al. Classification of thyroid fine-needle aspiration cytology into Bethesda categories:An institutional experience and review of the literature[J]. Cytojournal,2018, 15:4.
[4]刘芳,何欣,张丽,等.甲状腺细针穿刺细胞学漏诊与误诊15例分析[J].临床与实验病理学杂, 2017, 33(8):922-924.
[5]张波,徐景竹,吴琼. 2015年美国甲状腺学会《成人甲状腺结节与分化型甲状腺癌诊治指南》解读:超声部分[J].中国癌症杂志, 2016, 26(1):19-24.
[6]杨斌,薛德斌,主译.甲状腺细胞病理学杂志Bethesda报告系统:定义、标准和注释[M].北京:北京科学技术出版社, 2010:6.
[7]孙大菊,张文杰,闻春艳. 10 800例甲状腺细针穿刺细胞学病理诊断分析[J].中国实验诊断学, 2015, 19(11):1916-1917.
[8]李文波,朱庆莉,张波,等.超声引导下细针吸取细胞学检查对甲状腺结节的诊断价值[J].中国医学科学院学报, 2010,32(1):76-79.
[9]赵秀娜,吴凤霞,李玉宏.超声弹性成像对甲状腺良恶性肿瘤的鉴别诊断[J].广东医学, 2010, 31(20):2672-2674.
[10]陈越峰,丛淑珍,王煜,等.超声弹性成像鉴别诊断实性甲状腺良、恶性小结节[J].中国医学影像技术, 2012, 28(2):252-255.
[11]魏芳,黄品同,闻卿,等.超声引导无负压吸引细针穿刺细胞学检查对甲状腺良恶性结节的诊断价值[J].中华超声影像学杂志, 2014, 23(7):630-631.
[12]谭翠霞,喻国,崔亭.超声引导下甲状腺细针穿刺传统涂片与液基细胞学对甲状腺结节性质诊断的对比研究[J].四川医学,2017, 38(1):75-79.
[13]张晓青,陈卉.超声引导下细针穿刺细胞学检查在甲状腺良恶性结节中的诊断价值[J].浙江医学, 2017, 39(17):1478-1480.
[14]李晨,李建宁,杨裕辉,等.超声引导下细针穿刺细胞学检查在甲状腺微小结节良恶性鉴别诊断中的应用价值[J].中国临床医学影像杂志, 2017, 28(3):223-225.
[15]刘军,余小蒙,彭继英,等.超声引导下甲状腺细针穿刺活检992例的临床与病理分析[J].广东医学, 2017, 38(4):588-591.
[16]吴敏,张捷,金志斌,等.弹性成像在细针穿刺诊断甲状腺恶性肿瘤中的应用价值[J].中华内分泌代谢杂志, 2014, 30(4):307-311.
[17]孔德华,黄丽丽,周琦,等.甲状腺良恶性结节超声弹性成像的误诊分析[J].中国超声医学杂志, 2014, 30(11):968-970.
[18] Das DK, Al-Waheeb SK, George SS, et al. Contribution of immunocytochemical stainings for galectin-3, CD44, and HBME1to fine-needle aspiration cytology diagnosis of papillary thyroid carcinoma[J]. Diagn Cytopathol, 2014, 42(6):498-505.
[19] Isic Dencic T, Cvejic D, Paunovic I, et al. Cytokeratin19 expression discriminates papillary thyroid carcinoma from other thyroid lesions and predicts its aggressive behavior[J]. Med Oncol, 2013,30(1):362.
[20] Barroeta JE, Baloch ZW, Lal P, et al. Diagnostic value of differential expression of CK19, galectin-3, HBME-1, erk, retand p16 in benign and malignant follicular-derived lesions of the thyroid:all immunohistochemical tissue microarray analysis[J].Endocr Pathol, 2006, 17(3):225-234.
[21]白杨,孙璐,郭爱桃,等. CK19、galectin-3和syndecan-1在甲状腺乳头状病变鉴别诊断中的意义[J].诊断病理学杂志,2013, 20(12):771-774.
[22]胡孟钧,吕艳婷,郦秀芳,等. CK19、TPO、CD56、p63标记在甲状腺良恶性乳头状增生诊断与鉴别诊断中的价值[J].临床与实验病理学杂志, 2011, 27(5):544-546.
[23] Liu S, Gao A, Zhang B, et al. Assessment of molecular testingin fine-needle aspiration biopsy samples:an experience in a Chinese population[J]. Exp Mol Pathol, 2014, 97(2):292-297.
[2]Nandedkar SS, Dixit M, Malukani K, et al. Evaluation of thyroid lesions by fine-needle aspiration cytology according to Bethesda system and its histopathological correlation[J]. Int J Appl Basic Med Res, 2018, 8(2):76-82.
[3]Alshaikh S, Harb Z, Aljufairi E, et al. Classification of thyroid fine-needle aspiration cytology into Bethesda categories:An institutional experience and review of the literature[J]. Cytojournal,2018, 15:4.
[4]刘芳,何欣,张丽,等.甲状腺细针穿刺细胞学漏诊与误诊15例分析[J].临床与实验病理学杂, 2017, 33(8):922-924.
[5]张波,徐景竹,吴琼. 2015年美国甲状腺学会《成人甲状腺结节与分化型甲状腺癌诊治指南》解读:超声部分[J].中国癌症杂志, 2016, 26(1):19-24.
[6]杨斌,薛德斌,主译.甲状腺细胞病理学杂志Bethesda报告系统:定义、标准和注释[M].北京:北京科学技术出版社, 2010:6.
[7]孙大菊,张文杰,闻春艳. 10 800例甲状腺细针穿刺细胞学病理诊断分析[J].中国实验诊断学, 2015, 19(11):1916-1917.
[8]李文波,朱庆莉,张波,等.超声引导下细针吸取细胞学检查对甲状腺结节的诊断价值[J].中国医学科学院学报, 2010,32(1):76-79.
[9]赵秀娜,吴凤霞,李玉宏.超声弹性成像对甲状腺良恶性肿瘤的鉴别诊断[J].广东医学, 2010, 31(20):2672-2674.
[10]陈越峰,丛淑珍,王煜,等.超声弹性成像鉴别诊断实性甲状腺良、恶性小结节[J].中国医学影像技术, 2012, 28(2):252-255.
[11]魏芳,黄品同,闻卿,等.超声引导无负压吸引细针穿刺细胞学检查对甲状腺良恶性结节的诊断价值[J].中华超声影像学杂志, 2014, 23(7):630-631.
[12]谭翠霞,喻国,崔亭.超声引导下甲状腺细针穿刺传统涂片与液基细胞学对甲状腺结节性质诊断的对比研究[J].四川医学,2017, 38(1):75-79.
[13]张晓青,陈卉.超声引导下细针穿刺细胞学检查在甲状腺良恶性结节中的诊断价值[J].浙江医学, 2017, 39(17):1478-1480.
[14]李晨,李建宁,杨裕辉,等.超声引导下细针穿刺细胞学检查在甲状腺微小结节良恶性鉴别诊断中的应用价值[J].中国临床医学影像杂志, 2017, 28(3):223-225.
[15]刘军,余小蒙,彭继英,等.超声引导下甲状腺细针穿刺活检992例的临床与病理分析[J].广东医学, 2017, 38(4):588-591.
[16]吴敏,张捷,金志斌,等.弹性成像在细针穿刺诊断甲状腺恶性肿瘤中的应用价值[J].中华内分泌代谢杂志, 2014, 30(4):307-311.
[17]孔德华,黄丽丽,周琦,等.甲状腺良恶性结节超声弹性成像的误诊分析[J].中国超声医学杂志, 2014, 30(11):968-970.
[18] Das DK, Al-Waheeb SK, George SS, et al. Contribution of immunocytochemical stainings for galectin-3, CD44, and HBME1to fine-needle aspiration cytology diagnosis of papillary thyroid carcinoma[J]. Diagn Cytopathol, 2014, 42(6):498-505.
[19] Isic Dencic T, Cvejic D, Paunovic I, et al. Cytokeratin19 expression discriminates papillary thyroid carcinoma from other thyroid lesions and predicts its aggressive behavior[J]. Med Oncol, 2013,30(1):362.
[20] Barroeta JE, Baloch ZW, Lal P, et al. Diagnostic value of differential expression of CK19, galectin-3, HBME-1, erk, retand p16 in benign and malignant follicular-derived lesions of the thyroid:all immunohistochemical tissue microarray analysis[J].Endocr Pathol, 2006, 17(3):225-234.
[21]白杨,孙璐,郭爱桃,等. CK19、galectin-3和syndecan-1在甲状腺乳头状病变鉴别诊断中的意义[J].诊断病理学杂志,2013, 20(12):771-774.
[22]胡孟钧,吕艳婷,郦秀芳,等. CK19、TPO、CD56、p63标记在甲状腺良恶性乳头状增生诊断与鉴别诊断中的价值[J].临床与实验病理学杂志, 2011, 27(5):544-546.
[23] Liu S, Gao A, Zhang B, et al. Assessment of molecular testingin fine-needle aspiration biopsy samples:an experience in a Chinese population[J]. Exp Mol Pathol, 2014, 97(2):292-297.
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