微波消融改善甲状腺结节粗针穿刺活检的过程与结果

目的 探讨微波消融对甲状腺结节粗针穿刺活检标本质量、出血风险和病理结果的影响。方法 对251例甲状腺单发结节在微波消融前、消融后进行双重粗针穿刺活检，比较2次取材标本质量满意度、穿刺后甲状腺出血程度、病理切片可判读性及病理诊断结果的前后一致性。结果 甲状腺结节消融前、消融后组织学标本质量满意度分别为92.03%（231/251）、100%（251/251），消融后标本质量满意度较消融前提高（P=0.000）。消融前、消融后活检出血发生率分别为15.14%（38/251）、0%，消融后出血发生率较消融前降低（P=0.000）。251例甲状腺结节中良性结节184例，乳头状癌结节67例，除4例因微波消融前穿刺活检标本质量差而无法制片外，其余结节消融前和消融后粗针穿刺活检病理诊断总体一致性为100%。结论 微波消融术后即刻粗针穿刺活检不影响甲状腺结节病理诊断准确性，并且具有减少出血风险、改善标本质量的优点。
Objective To explore the effect of microwave ablation on the specimen quality, risk of bleeding and histopathological outcomes of core needle biopsy in thyroid nodules. Methods Core needle biopsy were performed on 251 cases of thyroid solitary nodules before and after microwave ablation, and then the specimen quality, hemorrhage of thyroid nodules after biopsy, legibility of pathological slices and the consistency of pathological diagnosis were compared. Results The specimen satisfaction rate of thyroid nodules after microwave ablation was significantly improved compared with that before microwave ablation (100%[251/251] vs 92.03%[231/251], P=0.000), and the incidence of bleeding after microwave ablation was significantly decreased versus that before microwave ablation (0% vs 15.14%[38/251]; P=0.000). And 184 of 251 thyroid nodules were benign and 67 were papillary thyroid carcinoma. In addition to 4 thyroid nodules which could not be sliced due to poor quality before microwave ablation, the overall consistency of pathological diagnosis in the remaining nodules before and after microwave ablation was 100%. Conclusion Core needle biopsy immediately after microwave ablation does not affect the diagnostic accuracy of thyroid nodules, and can reduce the risk of bleeding and improve the specimen quality