摘要目的 评价甲状腺细针穿刺细胞学(FNAC)检查及其Bethesda报告系统的临床应用价值.方法 回顾性分析2043例甲状腺FNAC检查的细胞病理诊断结果.细胞学诊断标准严格参照Bethesda报告系统,分为6类,为标本无法诊断、良性病变、意义不明确的细胞不典型病变/滤泡性病变(AUS/FLUS)、滤泡性肿瘤/可疑滤泡性肿瘤(FN/SFN)、可疑恶性肿瘤(SM)和恶性肿瘤.对其中经手术治疗的234例患者的细胞病理与组织病理结果进行对比分析.结果 2043例行FNAC检查患者中,标本无法诊断占15.7％ (320/2 043),良性病变占51.2％(1047/2043),AUS/FLUS占16.6％(339/2043),FN/SFN占2.3％(46/2043),SM占8.6％ (176/2043),恶性肿瘤占5.6％(115/2043).234例手术患者中,细胞学诊断的恶性风险分别为:标本无法诊断(2/11),良性病变(2.2％,1/45),AUS/FLUS(25.6％,10/29),FN/SFN(12.1％,10/39),SM(91.8％,56/61),恶性肿瘤(100.0％,45/45).甲状腺FNAC诊断甲状腺结节的敏感度为87.1％(101/116)、特异度为95.3％(102/107)、假阳性率为4.7％(5/107)、假阴性率为12.9％(15/116)、总准确率为91.0％(203/223).结论 甲状腺FNAC检查是甲状腺疾病的可靠诊断方法,其Bethesda报告系统是一个准确而有效的细胞学诊断报告系统,值得在临床上大力推广和应用.

abstractsObjective To evaluate the clinical value of thyroid fine needle aspiration cytology (FNAC) and the Bethesda system for reporting thyroid cytopathology (TBSRTC).Methods FNAC was performed for 2043 cases and cytopathological data were retrospectively analyzed.Cytopathological diagnoses according to TBSRTC were classified as non-diagnostic,benign,atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS),follicular neoplasm/suspicious for follicular neoplasm (FN/SFN),suspicious for malignancy(SM) and malignancy.The results of 234 FNAC samples in which surgery was performed were compared with the histological diagnoses.Results Of the 2043 FNAC samples,15.7％ (320/2043)were non-diagnostic,51.2％ (1047/2043)were benign,16.6％ (339/2043) were AUS/FLUS,2.3％ (46/2043) were FN/SFN,8.6％ (176/2043) were SM and 5.6％ (115/2043)were malignant.In 234 cases,there was follow-up histology.Rates of malignancy were as follows:non-diagnostic,18.2％ (2/11);benign (2.2％,1/45);AUS/FLUS (25.6％,10/29);FN/SFN (12.1％,10/39);SM(91.8％,56/61);malignant (100.0％,45/45).The sensitivity,specificity,false positive rate,false negative rate and overall accuracy of FNAC in the diagnosis of thyroid nodules was 87.1％(101/116),95.3％ (102/107),4.7％ (5/107),12.9％ (15/116),91.0％ (203/223).Conclusions FNAC is a reliable diagnostic method for evaluation of thyroid disease.TBSRTC is a accurate and effective reporting system for cytopathological diagnoses,so it is worthy of being widely popularized in clinical application.