القيمة التشخيصية للرشافة بالإبرة الرفيعة في تقييم العقد الدرقية ومقارنة الدراسة الخلوية مع الدراسة النسيجية
Abstract
دراسة استقرائية في مشفى تشرين الجامعي, لتقييم دقة الدراسة الخلوية للرشافة بالإبرة الرفيعة في تشخيص العقد الدرقية من خلال تقييم الترابط بين الدراسة الخلوية والدراسة النسيجية.
أجريت الدراسة ما بين كانون ثاني 2017 - حزيران 2018 على 49 مريض لديهم عقدة درقية، خضعوا لرشافة بالإبرة الرفيعة (FNA) وأجري لهم دراسة خلوية ولاحقا دراسة نسيجية تالية للجراحة. تم تصنيف النتائج وفقاً لتصنيف Betheseda إلى: عينات غير كافية للتشخيص, سليمة, آفة جريبية غير محددة الأهمية, تنشؤ جريبي, اشتباه بالخباثة, وخبيثة. تم اعتماد التشخيص النسيجي النهائي كمعيار ذهبي .
بلغت نسبة الذكور/الإناث: 1/7.2, وبلغ متوسط عمر المرضى 43.6 سنة.
تم تشخيص 39 حالة على أنها سليمة, 3 حالات غير كافية للتشخيص, حالتي تنشؤ جريبي, حالتي اشتباه بالخباثة, حالتي خباثة, وحالة واحدة آفة جريبية غير محددة الأهمية.
مثل الدراق العقيدي غالبية الحالات السليمة (62.8%), في حين شكلت الكارسينوما الحليمية أغلب الحالات الخبيثة (83.3%).
تمت مقارنة التشخيص بالدراسة الخلوية مع التشخيص النهائي النسيجي الموافق.
حققت الدراسة الخلوية للرشافة بالإبرة الرفيعة حساسية 83.3%, نوعية 97.4%, قيمة تنبؤية إيجابية 83.3%, قيمة تنبؤية سلبية 97.4%, معدل إيجابية كاذبة 2.5%, معدل سلبية كاذبة 16.6%, ودقة كلية 95.5%.
خلص البحث إلى أن الدراسة الخلوية للرشافة بالإبرة الرفيعة هي اختبار تشخيصي أولي حساس, نوعي و دقيق لتقييم مرضى العقد الدرقية.
Introduction : The main role of fine needle aspiration cytology (FNAC) lies in the differentiating between a malignant and benign thyroid nodule. It greatly influences the treatment decision.
Aim : This study aimed to evaluate the accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of thyroid nodules by evaluating the cytology–histopathology correlation .
Materials and Methods : This is a prospective study of 49 diagnosed cases of thyroid nodules who underwent FNAC and histological study of surgical biopsies for diagnosis at Tishreen University Hospital , during the period between march 2017 – march 2018 .The results were categorized according to Betheseda classification into: insufficient for diagnosis, benign, follicular lesion of undetermined significance, follicular neoplasm, suspicious for malignancy, and malignant sampling. The final histologic diagnosis was considered the gold standard.
Results : The study included 49 cases presented with thyroid nodules who underwent diagnostic thyroid FNAC. Female to male ratio was 7.2:1, and the mean age was 43.6 years.
Thirty –nine cases (79.6%) were diagnosed as benign, 3 cases (6.1%) as unsatisfactory , 2 cases (4.1%) as follicular neoplasm, 2 cases (4.1%) as suspicious for malignancy, 2 cases (4.1%) as malignant, and 1 case (2%) as follicular lesion of undetermined significance.
Nodular goitre represented the majority of benign cases (62.8%), while papillary carcinoma was the most frequent malignant lesion (83.3%).
Cytologic diagnoses were compared with their corresponding final histologic ones. FNAC achieved a sensitivity of 83.3%, a specificity of 97.4%, a positive predictive value of 83.3%, a negative predictive value of 97.4%, a false positive rate of 2.5% , a false negative rate of 16.6% , and a total accuracy of 95.5%.
Conclusion : FNA cytology is a sensitive, specific, and accurate initial diagnostic test for the evaluation of patients with thyroid nodules.
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