针径大小和穿刺手法对甲状腺结节细针穿刺细胞学检查标本满意率的影响

Influence of needle size and puncture technique on the rate of satisfactory specimens in fine-needle aspiration cytology of thyroid nodules

摘要:

目的 探讨不同型号穿刺针和穿刺手法对甲状腺结节细针穿刺细胞学检查（FNAC）标本满意率的影响。方法 回顾分析959例（1 018个）甲状腺结节FNAC患者临床资料，根据穿刺针直径大小及穿刺手法不同分为4组。22G前后组352例（382个），使用22G针配合前后穿刺手法；22G螺旋组289例（300个），使用22G针配合前后螺旋穿刺手法；25G前后组169例（177个），使用25G针配合前后穿刺手法；25G螺旋组149例（159个），使用25G针配合前后螺旋穿刺手法。比较4组方法检查结节的标本满意率。结果 22G前后组标本满意率80.9%，22G螺旋组标本满意率76.3%，25G前后组标本满意率84.2%，25G螺旋组标本满意率93.7%。25G螺旋组标本满意率高于其他3组（P均<0.05）。按结节彩超特征进一步比较，低回声结节中，25G螺旋组标本满意率高于其他3组（P均<0.05），大钙化结节中，25G螺旋组和22G螺旋组标本满意率高于25G前后组和22G前后组（P<0.05）。结论 不使用负压抽吸的25G细针径联合前后螺旋穿刺手法的FNAC策略无需特殊设备，操作简单易行，可提升甲状腺结节FNAC的标本满意率。

Abstract:

Objective To investigate the influence of needle size and puncture technique on the rate of satisfactory specimens in fine-needle aspiration cytology (FNAC) of thyroid nodules. Methods Clinical data of 1 018 thyroid nodules FNAC were reviewed. Nodules were divided into four groups according to the diameter of needle size and puncture technique adopted, i.e. the 22G to-and-fro motion group (352/382) using 22G needle and to-and-fro motion puncture technique, the 22G to-and-fro motion with rotation group (289/300) using 22G needle and to-and-fro motion with axis rotation, the 25G to-and-fro motion group (169/177) using 25G needle and to-and-fro motion puncture technique, and the 25G to-and-fro motion with rotation group (149/159) using 25G needle and to-and-fro motion with axis rotation. The rates of satisfactory specimens of the four groups were calculated and compared. Results The rates of satisfactory specimens in the 22G to-and-fro motion group, the 22G to-and-fro motion with rotation group, the 25G to-and-fro motion group and the 25G to-and-fro motion with rotation group were 80.9%, 76.3%, 84.2% and 93.7%, respectively. The rate of satisfactory specimens in the 25G to-and-fro motion with rotation group was significantly higher than those of the other three groups (all P<0.05). Further comparisons based on the characteristics of the color Doppler echocardiography of nodules showed that the rate of satisfactory specimens for the hypoechoic nodules in the 25G to-and-fro motion with rotation group was significantly higher than those of the other three groups(all P<0.05), and the rates for the macrocalcification nodules in the 25G and 22G to-and-fro motion with rotation groups were significantly higher than those of the two to-and-fro motion groups(both P<0.05). Conclusion With advantages of no requirement of special equipments and simple operation, the FNAC without aspiration using a 25G needle and to-and-fro motion with rotation technique can improve rate of satisfactory specimens and reduce nondiagnostic specimens.