Objective To investigate the influencing factors of Bethesda Ⅲ results in fine-needle aspiration biopsy of thyroid nodules.Methods A total of 300 thyroid nodules with cytological diagnosis results were analyzed retrospectively,including 100 Bethesda Ⅲ nodules and 50 nodules of Bethesda Ⅱ,Ⅳ,Ⅴ,and Ⅵ categories,respectively.Univariate analysis and Logistic regression analysis were performed on the clinical data of patients and the ultrasound signs of thyroid nodules to clarify the factors influencing the diagnosis of Bethesda Ⅲ nodules.Results Univariate analysis showed that Bethesda Ⅲ nodules were mostly adjacent to the capsule(P<0.001),with no blood flow in the color Doppler assessment(P=0.011)and lack of blood supply(P=0.033)and maximum diameter ≤0.9 cm(P=0.038)as revealed by the contrast-enhanced ultrasound.Logistic regression showed that the position close to the capsule(OR=5.110,95%CI=2.153-12.130,P<0.001)and color Doppler without blood flow signal(OR=3.015,95%CI=1.094-8.311,P=0.033)were independent risk factors for the diagnosis of Bethesda Ⅲ nodules.Conclusions The puncture difficulty caused by the dangerous position of thyroid nodules close to the capsule and the aspiration difficulty caused by the absence of blood flow signal in color Doppler are the main factors influencing the diagnosis of Bethesda Ⅲ nodules.Therefore,corresponding avoidance measures should be taken during the aspiration process to reduce the diagnosis results of Bethesda Ⅲ nodules.
目的 探讨甲状腺结节细针穿刺活检Bethesda Ⅲ类结果的影响因素。方法 回顾性分析有细胞学诊断结果的300个甲状腺结节,其中Bethesda Ⅲ类结节100个,Bethesda Ⅱ、Ⅳ、Ⅴ、Ⅵ类结节各50个。对患者的临床资料及甲状腺结节超声征象等进行单因素分析和Logistic回归分析,明确Bethesda Ⅲ类结节诊断的影响因素。结果 单因素分析显示,Bethesda Ⅲ类结节多邻近被膜(P<0.001),彩色多普勒多呈无血流(P=0.011),超声造影多表现为乏血供(P=0.033),最大径多≤0.9 cm(P=0.038)。Logistic回归分析显示,结节邻近被膜(OR=5.110,95%CI=2.153~12.130,P<0.001)、彩色多普勒无血流信号(OR=3.015,95%CI=1.094~8.311,P=0.033)是诊断Bethesda Ⅲ类结节的独立危险因素。结论 甲状腺结节邻近被膜危险位置造成的穿刺技术难度增加及结节彩色多普勒无血流造成的取材困难是诊断Bethesda Ⅲ类结节的主要影响因素,应在穿刺的过程中采取相应的规避措施降低Bethesda Ⅲ类结节的诊断率。.
Keywords: fine-needle aspiration; influencing factor; pathological results; thyroid nodule.