- 期刊
細針抽取細胞學與冰凍切片檢查在診斷甲狀腺病變之比較
Comparison Between Fine-Needle Aspiration Cytology and Frozen Section Examination in the Diagnosis of Thyroid Lesions
摘要
背景：細針抽取細胞學目前被廣泛使用在甲狀腺疾患的診斷，它具有高準確度及特異性，既方便又經濟。然而，細針抽取細胞學是否可以取代冰凍病理切片的角色，文獻結論不一。本研究要探討兩者在診斷甲狀腺疾患所扮演的角色與差異。 方法：自1995年1月至1999年12月，共有289名患者同時接受術前細針抽取細胞學及術中冰凍病理切片的檢查。分別依最後永久病理切片結果為依據，用Wilcoxon Signed Ranks Test比較細針抽取細胞學及冰凍病理切片兩者在診斷上的一致性。同時運用Cochran-Mantel-Haenszol Chi-square Test比較兩者的診斷準確度是否有差異。 結果：細針抽取細胞學的診斷準確度、敏感性及特異性分別為78.1%、82.8%及75.5%，有較高的偽陽性率（p-value = 0.001）。而冰凍病理切片平均診斷準確度、敏感性及特異性分別為86.5%、88.9%及85.3%，有較高的真陽性率（p-value = 0.001）。冰凍病理切片無論在診斷良性或惡性病灶，其敏感度及特異性都比細針抽取細胞學高（p-value = 0.008）。 結論：細針抽取細胞學是一項良好的第一線診斷工具，它在分辨甲狀腺良性與惡性腫瘤具有高準確度與特異性，可以做為手術與否的一項參考指標。然而，它不能完全替代冰凍病理切片的角色。無論良性或惡性腫瘤，冰凍病理切片可輔助細針抽取細胞學，提供更好的臨床診斷。
並列摘要
BACKGROUND: Fine-needle aspiration cytology (FNAC) is the most widely used screening test for thyroid lesions. It is simple, cost-effective and has high diagnostic accuracy and specificity. There is doubt, however, as to whether FNAC can replace intraoperative frozen section (FS) examination. The merits and differences of these two examinations are discussed. METHOD: This series is a retrospective review of 289 patients who underwent both FNAC and FS examinations at the Department of Otolaryngology, Changhua Christian Hospital between January 1995 and December 1999. The consistency of FNAC and FS were compared by stratifying pathology results with the Wilcoxon Signed Ranks test. The diagnostic accuracy of these two examinations was also compared with the Cochran-Mantel-Haenszol chi-square test. RESULTS: FNAC had a higher false positive rate (p-value = 0.001) and FS had a higher true positive rate (p-value = 0.001). FS examination had higher diagnostic sensitivity and accuracy than FNAC both for benign and malignant lesions of the thyroid (p-value = 0.008). CONCLUSIONS: FNAC had a high degree of accuracy and specificity differentiating benign or malignant lesions of the thyroid and in selecting patients for thyroid surgery. Nevertheless, it should not completely replace FS examination. FS, when used in combination with FNAC, can provide a more rigorous clinical diagnosis, both in benign and malignant lesions of thyroid.