Ultrasound-guided Fine Needle Aspiration Cytology In Thyroid Nodules

Background : With the increasing prevalence of asymptomatic thyroid nodules,facing a large number of patients with thyroid nodules,an inspection method which is more accurate than the ultrasonic to determine those benign and malignant lesions is urgent needed.It has been widely accepted that the thyroid fine needle aspiration cytology is a routine examination tool to evaluation of thyroid nodules.However,this technique has not been adopted in China.Object: Through the large sample size of thyroid fine needle aspiration cytology and the descriptions of ultrasound for thyroid nodules description and the postoperative paraffin pathological analysis,to evaluate the clinical value of thyroid fine needle aspiration cytology and the significance of differential diagnosis,and explore the possibility of popularizing the application of fine needle aspiration cytology.Methods: A retrospectively review of clinical and pathological data from JAN2014 to DEC 2015 in the NO.1 Hospital of Da Lian Medical University,all thyroid nodules were admitted to the fine needle aspiration cytology and treated by surgery.Preoperative fine needle aspiration biopsy of 276 patients were compared with final surgical pathologic results,the sensitivity,accuracy and specificity of FNA diagnosis for thyroid nodules were evaluated by using histologic diagnosis as a gold standard.The accuracy,sensitivity,specificity,false positive rate and false negative rate of the four groups were compared according to the size of thyroid nodules.Using SPSS statistical software to analysis data,count data using χ2 test,the difference was statistically significant if P<0.05.Focus on access and evaluate the inconsistent thyroid nodules smear,which fine needle aspiration biopsy and histological pathological are different,and determine a clear cause of misdiagnosis.Results:1、With the evaluation criteria change,from benign to follicular active to suspicious malignant transformation to cancer,the malignant rate of postoperative histopathology is gradually increasing.2 、 Compared the postoperative histopathology with the preoperative fine needle aspiration biopsy,known for thyroid FNA diagnosis sensitivity of 91.3%,specificity:88.9%,accurate rate: 90.6%,false positive rate: 8.3%,false negative rate 7.9%.3、All thyroid nodules which suffered the fine needle aspiration biopsy were by color Doppler ultrasound examination,compared the preoperative grading of TI-RADS classification with histologic diagnosis,the sensitivity of the diagnosis: 88.3%,specificity: 77.8%,accuracy: 87.0%,false positive rate: 2.9%,false negative rate:11.0%.4、When the size of thyroid nodules < 1cm,the sensitivity was 84.7%,the accuracy rate of 85.0%,specificity85.7%,false positive rate of 2.4%,false negative rate was12.7%.When the size equal to 1-1.5cm,it’s sensitivity was 95.0%,the accuracy rate of 94.0%,specificity:85.7%,false negative rate: 4.5%,false positive rate of 1.5%,.When the thyroid nodules sizes 1.5-2 cm,the sensitivity was 95.0%.The accuracy rate was 94.0%,specificity:95.7%,;false negative rate: 4.3%;when size bigger than 2cm of thyroid nodules,the sensitivity was 97.1%,the accuracy rate of 97.2%,a specificity of50%,false negative rate: 2.8%.The above data by X2 test,it is concluded that P = 0.03,P value less than 0.05,we can think that the different size of thyroid nodules,thyroid nodules detected rate is not the same.A pair wise analysis of four groups of experimental group,we come to the conclusion that when size< 1cm in diameter and the other three groups of thyroid nodules detected in accordance with the rate difference is statistically significant,and the differences between the other three groups are not statistically significant.Conclusions:1、The FNAB examination of the thyroid for the benign and malignant thyroid nodules accurate rate is high,which is the most important examination tool for the clinical diagnosis of thyroid nodules.It has played a very important role in the selection of cases for clinicians.2、Combine the preoperative thyroid color Doppler ultrasound classification can help determine the need for FNAB examination patients,as well as help corresponding thyroid nodules whether to deal with or not and how to deal with.3、In the future diagnosis of thyroid fine needle biopsy,we should pay attention to avoid the false positive problem,promote the thyroid fine needle aspiration examination,which will greatly reduce the surgical treatment of benign thyroid nodules.