超声引导下粗针穿刺活检在甲状腺癌诊断中的应用研究-外科学专业论文.docxVIP

万方数据 万方数据 Application value of ultrasound-guided thyroid Core Needle Biopsy Histopathology A Dissertation Submitted to Shihezi University In Partial Fulfillment of the Requirements for the Degree of Master of Medicine By Yu Mingtao (Surgery) Dissertation Supervisor: Nu Jianhua May, 2015 摘要 目的：探讨超声引导下粗针穿刺活检(CNB)对甲状腺癌诊断中的临床意义。 方法：收集石河子大学医学院第一附属医院及兵团第七师医院自 2010年1 月至 2014 年 12 月彩超提示有可疑甲状腺癌结节的患者共计 287 例，在术前均行超声引导下粗针穿刺 活检术，从穿刺活检成功的 259 例中按完全随机设计的原则抽取 180 例作为研究对象， 通过计算 kappa 值 、准确率、灵敏度、特异度、漏诊率、误诊率、约登指数等指标探 讨超声引导下粗针穿刺活检(CNB)对甲状腺癌诊断中的临床意义。 结果：回顾收集 287 例研究对象中成功 259 例，发现并发症 16 例，随机抽取 180 例研 究对象粗针穿刺病理检查结果示：134 例为甲状腺乳头状癌，13 例为甲状腺滤泡癌，2 例为甲状腺髓样癌，25 例为结节性甲状腺肿，4 例为桥本氏甲状腺炎，2 例为甲状腺腺 瘤；经术后病理证实 153 例为甲状腺癌，其中甲状腺乳头状癌 136 例，甲状腺滤泡癌 13 例，未分化癌 1 例，髓样癌 3 例；非甲状腺癌 27 例，其中结节性甲状腺肿 23 例、桥本 氏甲状腺炎 2 例、甲状腺腺瘤 2 例。活检针穿刺正确 176 例，漏诊 4 例；通过统计学分 析提示 kappa 值 0.918、一致率 0.9778、灵敏度 97.39%；特异度 100%；漏诊率 2.61%； 误诊率 0；约登指数 0.974。 结论：超声引导下粗针穿刺活检对甲状腺癌具有极高的术前诊断价值,对甲状腺结节的 治疗具有重要的指导意义。 关键词:甲状腺恶性肿瘤；粗针穿刺；组织病理 I II万方数据 II 万方数据 Abstract Objective:To explore the value of ultrasonography (US) -guided needle biopsy in the diagnosis of the thyroid carcinoma. Methods: From 2010 January-2014 year in December 287 cases in the shihezi university school of medicine in the first affiliated hospital and the seventh division hospital which was suspected of Thyroid Carcinoma.And all the subjects were received the Ultrasound-guided needle aspiration biopsy before the operation. We drawed 180 patients as the subject investigated in the principle of completely randomized design from 259 patients who were successed . Compare the pathologic results of coarse needle aspiration biopsy to postoperative pathologic results referred as the diagnosis standard.Epidemiological indicators of concordance rate, kappa value, sensitivity, specificity, omission diagnostic rate, misdiagnosis rate, Youden index were used for evaluating the diagnostic value for thyroid carcinoma. Results: Coarse needle biopsy results 134 cases had been pathologically confirme