甲状腺结节超声引导下细针穿刺技巧及影响病检结果因素分析和解决办法

The Technique of Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules, Analysis of Factors Affecting Pathological Examination Results and Problem-Solving Methods

摘要: 目的：探讨超声引导下甲状腺结节细针穿刺技巧及影响病检结果因素分析和解决办法。方法：选择2018.01~2022.05在本院就诊的980例甲状腺结节患者为研究对象，探讨甲状腺结节超声引导下细针穿刺技巧，对影响病检结果的多种因素进行分析，同时寻找解决办法。结果：980例甲状腺结节患者中，无法诊断者103例，良性240例，意义不明确的细胞非典型病变或者滤泡性肿瘤348例，怀疑恶性180例，恶性者109例。无法诊断的103例患者中，低回声结节直径 ≤ 5 mm者31例，微钙化及环形钙化39例，多发性结节17例，结节纵横比 > 1者16例。结论：甲状腺结节超声引导下细针穿刺技巧，在日常工作中可以逐步提升。穿刺者的技术水平、甲状腺低回声结节直径 ≤ 5 mm、微钙化及环状钙化、多发性结节即良恶性结节并存是影响病检结果的主要因素。提高穿刺者技术水平、重复穿刺或改换粗针穿刺、结合BRAF V600E基因检测可提高甲状腺结节的诊断率。

Abstract: Objective: To explore the technique of ultrasound-guided fine needle aspiration of thyroid nodules, analyze the factors affecting the pathological examination results and problem-solving methods. Methods: A total of 980 patients with thyroid nodules who were treated in our hospital from January 2018 to May 2022 were included in the study. The technique of fine needle aspiration guided by ultrasound for thyroid nodules was discussed, and various factors affecting the results of the pathological examination were analyzed, and solutions were explored at the same time. Results: Among the 980 patients with thyroid nodules, 103 were undiagnosable, 240 were benign, 348 were atypical cellular diseases or follicular tumors, 180 were suspected malignant, and 109 were malignant. Among the 103 undiagnosable patients, 31 had hypo-echoic nodules with a diameter ≤ 5 mm, 39 had micro-calcifications and annular calcifications, 17 had multiple nodules, and 16 had nodule longitudinal dimension to transversal dimension ratio > 1. Conclusion: The skills of ultrasound-guided fine-needle aspiration of thyroid nodules can be gradually improved in daily work. The examiner’s puncture technique, the diameter of thyroid hypo-echoic nodule ≤ 5 mm, micro-calcification and annular calcification, multiple nodules, or the coexistence of benign and malignant nodules, were the main factors affecting the results of the pathological examination. Improving the technical level of the punctureer, repeating the puncture or changing fine needle to thick needle, combined with the BRAF V600E gene test can improve the correct diagnostic rate of thyroid nodules.