国外甲状腺结节细针穿刺活检临床指南综述

V. Petrov, A. Nelaeva, E. Molozhavenko, E. Ivashina
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引用次数: 2

摘要

细针穿刺活检(FNA)是评估甲状腺结节最准确和最经济有效的方法。FNA结果对恶性肿瘤的风险分层有用,并为确定手术的适当性提供关键信息。然而,我们应该记住,FNA是一种侵入性的诊断方法,因此有可能出现并发症。有可能出现非诊断性、假阳性和假阴性结果,从而导致延迟或不必要的手术。我们看到甲状腺结节的发病率越来越高,主要与超声诊断该器官的可用性增加有关。因此,参与制定甲状腺病理诊断和治疗临床指南的主要组织建议限制FNA的实施。在某些情况下使用这种方法是不必要的,有时甚至可能对患者造成危险。在做出临床决定时,应考虑甲状腺结节的声像图表现和患者的个体遗忘及临床因素。对于小甲状腺结节,FNA在大多数情况下是不必要的。根据声像图的表现而不是根据阈值节点的大小来判断更为合理。恶性肿瘤的具体声像图表现为:钙化、边缘不规则、低回声结节、高过宽、颈部淋巴结转移和甲状腺外扩张。这些征象的总和对甲状腺结节恶性风险的分层和决定是否需要FNA是有用的。
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Overview of foreign clinical guidelines for the use of fine-needle aspiration biopsy of thyroid nodules
Fine-needle aspiration biopsy (FNA) is the most accurate and cost-effective method for evaluating thyroid nodules. FNA results are useful for stratifying the risk of malignant neoplasms and provide key information to determine the appropriateness of an operation. However, we should keep in mind that FNA is an invasive diagnostic method, so there is a possibility of complications. There is a likelihood of nondiagnostic, false positive and false negative results that can lead to a late or unnecessary operation. We see a growing incidence of thyroid nodules, associated mainly with the increased availability of ultrasound diagnostic of this organ. So the leading organizations involved in the development of clinical guidelines for diagnostics and treatment of thyroid pathologies suggest limiting the conduct of FNA. The use of this method in some cases is not necessary and at times can be even dangerous to a patient. When making clinical decisions, sonographic patterns of thyroid nodules and individual anamnestic and clinical factors of the patient should be considered. For small thyroid nodules, the FNA in most cases is not necessary. It is more rational to make a decision based on sonographic patterns rather than be guided by a threshold node size of > 1 cm. The specific sonographic patterns of malignancy are: presence of calcifications, irregular margins, hypoechoic nodule, taller-than-wide shape, metastases to the cervical lymph nodes, and extrathyroidal extension. The totality of these signs is useful for stratifying the risk of malignancy of the thyroid nodules and deciding on the need for FNA.
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