| PurposeIn recent years,the incidence of thyroid cancer around the world is on the rise,especially the rapid increase of thyroid papillary carcinoma with the lesion diameter less than 10 mm.How to find a fast,simple,accurate and economical diagnostic method making right pathological diagnosis of thyroid cancer has become a new hot spot in the study for clinical research.In 2012,the cell room of the pathology department and the thyroid surgical department of China-Japan Union Hospital of Jilin University cooperated to be the first in Jilin Province to execute a new technology research that using ultrasound-guided fine needle aspiration cytology without negative pressure to diagnose thyroid microcarcinoma.The current study mainly retrospective analyses diagnosis cases of ultrasound-guided fine needle aspiration cytology without negative pressure and compared with histopathological diagnosis so as to investigate the diagnostic value for thyroid microcarcinoma in ultrasound-guided fine needle aspiration cytology without negative pressureComparing the cytological diagnosis and pathological diagnosis of2448 nodules in 2137 patients to summarize and analyze how to improve the level and diagnosis experience of fine needle aspiration cytology without negative pressure in thyroid.Methods1.In the period from May 2016 to July 2017,a total of 8152 cases of which were in the diagnosis of fine needle aspiration cytology without negative pressure were collected from cell room of the pathology department of China-Japan Union Hospital of Jilin University.In these cases,2448 nodules from 2137 patients were surgically removed and confirmed by histopathology.The age range of patients was from 10 to70 years old.The Bethesda classification of cytopathology was utilized in cytological diagnosis and divided into VI grade,respectively:Grade?indicated specimens could not be diagnosed or not satisfied;Grade?indicated benign disease;Grade?indicated atypical lesions of cells with undermined characteristic or follicular lesions;Grade?indicated follicular or suspicious follicular tumors;Grade V indicated suspicious tumors and Grade?indicated malignancies.The WHO Criteria for Thyroid Classification(2016 version)was used in pathological classification,and divided into benign and malignant.2.The collected cells were from outpatients or inpatients of thyroid surgery and the thyroid surgeons checked the suspicious malignant nodules by using high-frequency ultrasound,then recommended cytological puncture.Puncture was operated by the thyroid surgeons and the brand of color Doppler ultrasound diagnostic apparatus was Hitachi from Japan.The linear probe,disposable 5 ml plastic syringe and Japan eight light 22G needle were used.Patients were in supine position,neck pad and fully exposed thyroid.1%lidocaine local anesthesia was used.and the puncture doctor recorded the nodule shape based on the medical record,echo and other conditions under the guidance of ultrasound puncture.Patients were required not to swallow and cough.The physician held the probe with the left hand and chose a good path.The right hand was utilized to carry out needles and repeated puncturing without negative pressure on the suspicious nodules.Conventional puncture was2-4 needles,smear was 4-8 pieces and immediately 95%ethanol fixed,then sent to the cell compartment.Observed patients for bleeding and other complications and bandaged with sterile gauze.Thirty minutes later,if there was no abnormal situation,patients could be out of the hospital.After the puncture examination,doctors should collect puncture data and record contact information.Physicians of cell room would fix puncture smear conventional pasteurization,read film and send the report,then archive.3.The collected tissues from patients were fixed with a neutral formalin solution,followed by dehydrated by automatic dehydration machine,transparently and immersed in wax,embedded in paraffin,sliced,fully stained with HE,stained,mounted,read,and archived.4.Cytological statistical analysis was used SPSS16.0 software.The normal measurement data were expressed as mean±standard deviation and non-normal measurement data were expressed with the median.Measurement data were compared using group t-test,comparisons of comparisons using x~2 test.p<0.01 for the difference was statistically significant.Results1.There were 432 males(20.22%)and 1705 females(79.78%)among patients,females was significantly more than males.2.The age range of surgical patients was 10 to 70 years,with a median age of 44.81±10.39 years.6 patients aged 10-19 years,accounting for 0.28%;182 patients aged 20-29 years,accounting for8.52%;488 patients aged 30-39 years,accounting for 22.84%;715patients aged 40-49 years,accounting for 33.46%;577 patients aged50-59 years,accounting for 27.00%and 169 cases of patients aged 60-70years,accounting for 7.90%.Most patients aged 40-49 years and it was higher than 30-39 years old patients and 50-59 years old patients,and the number of patients in 10-19 years old and 60-70 years were least.3.In 2448 nodules,histology clearly diagnosis 2278 nodules of thyroid papillary carcinoma,accounting for 93.05%.The results indicated that the incidence of thyroid cancer was rapidly increased and mainly due to the rapid increase of thyroid papillary carcinoma.4.The cytological diagnosis of 2448 nodules was graded as followed:Grade?was 15 cases,accounting for 0.61%;Grade?was 105 cases,accounting for 4.29%;Grade?was 75 cases,accounting for 3.06%;Grade?was 18 cases,accounting for 0.74%;Grade V was 296 cases,accounting for 12.09%and Grade?1939 was cases,accounting for79.21%.Histopathological diagnosis of benign was 144 cases,accounting for 5.88%and malignant was 2304 cases,accounting for 94.12%.Respectively papillary carcinoma was 2278 cases,accounting for 93.05%;follicular carcinoma was 8 cases,accounting for 0.33%;medullary carcinoma was 8 cases,accounting for 0.33%;undifferentiated carcinoma was 1 case,accounting for 0.04%;nodular goiter(with adenoma)was132 cases,accounting for 5.39%;Hashimoto's thyroiditis was 19 cases,accounting for 0.78%;and subacute thyroiditis was 2 cases,accounting for 0.08%.5.Cytological diagnosis of Grade I was 15 cases.postoperative pathological diagnosis of benign was 12 cases and malignant was 3 cases.Cytological diagnosis of Grade?was 105 cases.postoperative pathologicaldiagnosis of benign was 86 cases and malignant was 19cases.Cytological diagnosis of Grade III was 75 cases.postoperative pathologicaldiagnosis of benign was 15 cases and malignant was 60cases.Cytological diagnosis of Grade IV was 18 cases.postoperative pathological diagnosis of benign was 3 cases and malignant was 15 cases..CytologicaldiagnosisofgradeVsuspectedcancer296,histopathological diagnosis of thyroid cancer 287,the coincidence rate of96.96%..Cytological diagnosis of grade VI thyroid cancer 1939,histopathological diagnosis of thyroid cancer 1911,the coincidence rate of 98.56%.Conclusions1.The new technology of ultrasound-guided fine needle aspiration cytology without negative pressure in thyroid microcarcinoma diagnosis enabled the early detection of thyroid microcarcinoma with a high diagnostic compliance rate.and it is great significance to the diagnosis of thyroid microcarcinoma.2.The new technology of ultrasound-guided fine needle aspiration cytology without negative pressure in thyroid microcarcinoma diagnosis was safe,simple,fast,small damage and worth popularizing. |
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