Influence Analysis for Ultrasound-guided FNA with LBP cytology in Thyroid Disease Diagnosis

Autor: LIN, WEN-CHUN, 林玟君
Rok vydání: 2018
Druh dokumentu: 學位論文 ; thesis
Popis: 106
Thyroid nodules (TN) are common and became an important clinical problem. About 95% of thyroid cancers are single nodule, but the chance of malignancy is less than 15%. With the increase in the incidence of thyroid cancer in Taiwan, it is important to diagnose thyroid disease through ultrasound-guided fine needle aspiration and cytology report. Traditionally, non-surgeon physicians including radiologists or endocrinologists, performed ultrasound guided-fine needle aspiration through thyroid nodules. In recent years, more and more newly trained surgeons including general surgeons or head and neck surgeons have used ultrasound to treat thyroid diseases. Compared with the Conventional smear(CS) method, the Liquid-based preparation(LBP) cytology is not affected by the human factors, allows the samples to be better preserved, reduces the rate of non-diagnostic rate, and the sample can be used for cell block. It is the most competitive alternatives to replace Conventional smear till now. This study collected data during the period by the clinical data bank of the hospital, including patients who received thyroid nodule aspiration by non-surgeon physicians performed ultrasound guided-fine needle aspiration with Conventional smear cytology during 2015/5/1~2016/5/1 and Head and neck surgeon performed ultrasound guided-fine needle aspiration with liquid-based preparation cytology during 2016/5/1~2017/5/1. The results of our study showed that head and neck surgeons performed ultrasound guided-fine needle aspiration with liquid-based preparation cytology had lower non-diagnostic rate; the surgical rate was none significant between the two groups; the sensitivity and diagnostic rate were higher; the false negative rate was also lower. In the analysis of the causes of false negatives, we found that smaller nodules (less than 2 cm), ultrasound image revealed more than one nodule, calcification, cystic changes, ill-defined margins, and pathological proved non-papillary carcinoma may be associated with false-negative results. Therefore, we suggested the patient should receive more aggressive treatment plan including unilateral thyroidectomy or repeated fined needle aspiration within 1-2 months when the patients meet more than one feature as above before surgery to avoid false negative results.
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