Page 51 - 南京医科大学学报自然科学版

第44卷第1期 南京医科大学学报（自然科学版）
2024年1月 Journal of Nanjing Medical University（Natural Sciences） · 45 ·

·临床研究·

国际标准化超细针穿刺甲状腺结节不同细胞学采集模式诊断

率的比较

谷志远 ，王知笑 ，蔡 赟 ，崔 岱 ，陈欢欢 ，戎 荣 ，杨 涛 ，刘晓云 1*
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南京医科大学第一附属医院内分泌科，江苏 南京 210029；南京大学医学院附属鼓楼医院内分泌科，江苏 南京
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210008；南京医科大学第一附属医院病理科，江苏 南京 210029
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［摘 要］ 目的：评价甲状腺结节穿刺时不同留样顺序对细胞学诊断率的影响。方法：共入选591例甲状腺结节患者的613个甲
状腺结节，所有甲状腺结节均行 4 针细针穿刺，分为两种模式进行。模式一：304 个结节穿刺，前 2 针进行涂片细胞学检查，
后 2 针再进行液基细胞学检查；模式二：309 个结节穿刺，前 2 针进行液基细胞学检查，后 2 针再进行传统涂片细胞学制片。
细胞病理医师采用盲法单独对每份样本进行读片。比较不同细胞学制片方法以及两种模式对细针穿刺诊断率的影响。
结果：先液基后涂片的细胞学采集模式总体诊断率为 82.2%，显著高于先涂片后液基的模式（74.7%）（P=0.023）。对于直径
≥10 mm 的结节来说，先液基后涂片的细胞学采集模式总体诊断率为 83.2%，同样显著高于先涂片后液基模式的诊断率
（75.4%）（P=0.048）；同为前 2 针，单独液基方法诊断率为 78.0%，显著高于单独涂片诊断率（63.8%）（P < 0.001）；对于直径
≥10 mm的结节而言，单独液基诊断率为78.3%，亦显著高于单独涂片的诊断率（62.6%）（P < 0.001）。结论：使用国际标准化超
细针进行甲状腺细针穿刺，先液基再涂片的细胞学采集模式诊断率显著高于先涂片后液基的采集模式；如果仅以一种方式来
收取细胞学标本，沉降式液基细胞采集制片的方法诊断率显著优于传统涂片制片方法。
［关键词］ 甲状腺细针穿刺；甲状腺结节；涂片细胞学；液基细胞学
［中图分类号］ R446.8 ［文献标志码］ A ［文章编号］ 1007⁃4368（2024）01⁃045⁃07
doi：10.7655/NYDXBNSN230353

Comparison of adequacy rate between different cytology sampling models for thyroid
nodules using internationally standardized super⁃fine needle aspiration

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GU Zhiyuan ，WANG Zhixiao ，CAI Yun ，CUI Dai ，CHEN Huanhuan ，RONG Rong ，YANG Tao ，LIU Xiaoyun 1*
1 Department of Endocrinology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029；
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Department of Endocrinology，Drum Tomer Hospital affiliated to Nanjing University Medical School，Nanjing
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210008；Department of Pathology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，
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［Abstract］ Objective：To evaluate the effects of the two different models on diagnostic rates using different combinations of smear
and liquid⁃based cytology during thyroid fine needle aspiration（FNA）. Methods：We recruited 613 thyroid nodules from 591 patients
with thyroid nodules. All thyroid nodules underwent four passes of FNA in two modes. Mode 1，304 nodules were aspirated with the
first two passes for traditional smear，while the latter two passes using SurePath with liquid⁃based cytology. Mode 2，the other 309
nodules were aspirated in the opposite sequence with the first two passes for liquid⁃based cytology，while the later two passes for
traditional smear cytology. The cytopathologists read each slide blindly and separately. The diagnostic rates of each model were
compared. Results：We found that the diagnostic rate of the mode 2 with the first two passes for liquid⁃based cytology using SurePath
and the latter two passes for conventional smear was 82.2%，which was significantly higher than 74.7%（P=0.023）in the group of mode
1 using the first two passes for conventional smear and the following two passes for liquid⁃based cytology using SurePath. For nodules
larger or equal to 10 mm，the diagnostic rate of the mode 2 was 83.2%，which was also significantly higher than the diagnostic rate of

［基金项目］ 江苏省自然科学基金（BK20220715）；伊犁州临床医学研究院研究基金（yl2021ms03）
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通信作者（Corresponding author），E⁃mail：xliu@njmu.edu.cn