| Objective: To compare the application value of 23 G and 25 G needles used in the ultrasound guided thyroid nodule fine needle aspiration cytology.Methods: A total of 229 patients(282 nodules)who were admitted to He Bei General H ospital from September 2019 to November 2020 for continuous surgical treatment and underwent ultrasound guided thyroid nodule needle aspiration cytology were selected as research objects,and a retrospective analysis was performed using surgical pathology as the gold standard.The US-FNAC of thyroid nodules pathological results were classified by The Bethesda System for Reporting Thyroid Cytopatjology and compared with postoperative pathology.Quantitative analysis was made on the number of cells in pathological specimens of the US-FNAC of thyroid nodules which used 23 G or 25 G needles.The diagnostic efficiency,sample bleeding rate,full needle track display rate and postoperative adverse reaction rate of 23 G and25G needles in the US-FNAC of thyroid nodules were qualitatively analyzed.Results:1.Among the 282 thyroid nodules,there were 205 malignant nodules(72.7%)and 77 benign nodules(27.3%).The pathology accuracy the sensitivity,specificity,positive predictive value and negative predictive value of US-FNAC pathological results of thyroid nodules were 85.8%,92.5%,76.0%,91.1% and 79.2%,respectively;2.In this study,the overall unsatisfactory rate of US-FNAC was 2.5%,and the unsatisfactory rate of 23 G needles and 25 G needles was 2.1% and3.4%,respectively,and the difference was not statistically significant(P>0.05).There was no significant difference in the efficacy of pathological diagnosis of US-FNAC between the two needles groups(P> 0.05);3.According to the diameter of thyroid nodules,282 thyroid nodules were divided into three groups: >10mm,5-10 mm and <5mm.There was no significant difference in the satisfaction of pathological sampling of US-FNAC between the two needle types in different diameter groups(P>0.05).In the <5mm group,the accuracy of pathological diagnosis of US-FNAC by the two needle types was 86.8% vs 65.2%,with significant difference(P<0.05).In different diameter groups,except for the difference in diagnostic accuracy of the <5mm group,there was no significant difference in diagnostic efficiency between the two needle types(P>0.05);4.In this study,we analyzed the cell count of US-FNAC smears of thyroid nodules under microscope,and removed 7 thyroid nodules which could not be diagnosed(ND/UNS),a total of 275 thyroid nodules.The number of cells obtained by US-FNAC smear of malignant nodules was more than that of benign nodules(10137.79 ±6123.63vs1275.07±1263.41),and the difference was statistically significant(P<0.05).In addition,the number of cells obtained by US-FNAC smear with 23 G needles was more than that with 25 G needles(8825.89±7139.09vs5848.45±5700.91).There was no significant difference in the number of US-FNAC cells in Bethesda category I,Bethesda category III and II,between the two acupuncture groups(P>0.05).In Bethesda category V and VI,the cell number of 23 G needles smear was higher than that of 25 G needles,with significant difference(P<0.05).Under the Bethesda category V and VI,the number of cells in 23 G needles smear was significantly higher than that in 25 G needles smear when the operation and pathology was malignant(P<0.05).The blood cell contamination rate of 23 G needles smear was higher than that of 25 G needles(8.7% vs 2.3%),and the difference was statistically significant(P<0.05);5.In this study,8 patients(2.8%)had intraoperative or postoperative adverse reactions,including 1 case of bleeding(0.4%),6 cases of neck discomfort(2.1%),and 3 cases of dizziness(1.1%).There was no significant difference in the occurrence of adverse reactions between the two needle types(P> 0.05).However,the incidence of bleeding,neck discomfort and dizziness with 23 G needles was higher than that with 25 G needles(0.5% vs 0%,2.6%vs 1.1% and 1.5% vs 0%).The display rate of the whole needle track in the23 G needles group(6.1%)was higher than that in the 25 G needles group(14.9%),and the difference was statistically significant(P<0.05).Conclusion:1.Both 23 G and 25 G needles can be used for the US-FNAC of thyroid nodules.The cell number of sample of 25 G needles was less than that of 23 G needles smear,but it did not affect the diagnostic efficiency.2.25 G needles can reduce the cytological contamination rate of smears compared with 23 G needles,so we suggest that 25 G needles should be selected as far as possible when the blood supply of thyroid nodules is abundant,so as not to cause pathological diagnosis due to blood cell cover in the smear.However,when the thyroid nodule is short of blood supply and the diameter is small(<5mm),we recommend using 23 G needles,which is more accurate than 25 G needles.3.Counting the cell count of US-FNAC smears is helpful for the operator or assistant to perform rapid on-site evaluation as alternate evaluators.4.In addition,when 23 G needles is selected for US-FNAC,the needle track is more likely to be fully displayed,which is more beneficial to the operation of the operating doctors.Meanwhile,the selection of 25 G needles has a smaller proportion of adverse reactions,and patients are more likely to tolerate it. |
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