摘要
目的:探讨甲状腺细针穿刺细胞学(FNAC)检查中良恶性肿瘤的误诊原因,分析因诊断方法学和取材局限性导致的假阴性及假阳性结果并提出优化策略。方法:回顾性分析6243例超声引导下甲状腺FNAC病例,以组织病理学诊断作为金标准,计算假阴性和假阳性率,评估两种诊断方法的一致性。结果:6243例甲状腺结节(直径2~40mm)中,6044例获得明确诊断,包括良性结节4370例,恶性结节1674例;在恶性结节中,甲状腺乳头状癌1364例,占82.7%;甲状腺滤泡状癌271例,占16.18%;甲状腺恶性淋巴瘤19例,占1.12%。FNAC与组织病理学诊断的总体符合率为96.8%(P<0.001),差异有显著性意义。误诊病例199例(3.2%),主要影响因素包括:①标本取材不足;②良恶性细胞形态学特征重叠;③细胞病理医师诊断经验差异。结论:建立多学科协作诊断模式并应用新型辅助诊断技术可有效降低甲状腺FNAC的误诊率。
Objective:To investigate the causes of misdiagnosis in thyroid fine needle aspiration cytology (FNAC) for differentiating benign and malignant tumors, analyze false–negative and false –positive results attributed to diagnostic methodology and sampling limitations,and propose optimization strategies. Methods:A retrospective analysis was conducted on 6243 ultrasound–guided thyroid FNAC cases.Using histopathological diagnosis as the gold standard, we calculated false–negative and false–positive rates and evaluated the concordance between the two diagnostic methods. Results:Among 6243 thyroid nodules (diameter:2~40 mm) , definitive diagnoses were achieved in 6044 cases (4370 benign, 1674 malignant) . Among those malignant nodules:Papillary thyroid carcinoma 1364 cases (82.7%);Follicular thyroid carcinoma 271 cases (16.18%);Thyroid malignant lymphoma 19 cases (1.12%) . The overall concordance rate between FNAC and histopathological diagnosis was 96.8% (P<0.001) , the difference is statistically significant. There were 199 misdiagnosed cases (3.2%) ,primarily influenced by:①Inadequate specimen sampling;② Overlapping morphological features of benign and malignant cells;③Variations in diagnostic experience among cytopathologists. Conclusion:Establishing a multidisciplinary collaborative diagnostic model and incorporating novel auxiliary technologies can effectively reduce misdiagnosis rates in thyroid FNAC.
作者
余静薇
马珩
颜芳
康劲松
余忠清
YU Jing–wei;MA heng;YAN Fang(The Department of Surgical Cytology Daignosi,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan 430030)
出处
《医学检验与临床》
2025年第11期19-22,共4页
Medical Laboratory Science and Clinics
关键词
甲状腺结节
细针穿刺
假阴性
假阳性
诊断准确性
Thyroid nodule
Fine-needle aspiration
False negative
False positive
Diagnostic accuracy
