甲狀腺與乳房細針穿刺細胞學檢查抹片充足性分析： 以臺灣某醫學中心為例

Abstract

摘 要 目標：我們回顧台灣某醫學中心的甲狀腺和乳房細針穿刺(FNA)抹片，評估其抹片充足性(smear adequacy)。 研究設計：自2004年四月一日至六月三十日共三個月間共收集503例甲狀腺細針穿刺(FNA)抹片和316例乳房細針穿刺(FNA)抹片加以重新檢視。所有這些抹片由一位病理醫師依據下列兩條件標準判定抹片充足性：甲狀腺細針穿刺抹片依據Kini的定義，乳房細針穿刺抹片依據Layfield的定義。所有患者於2005年六月三十日，約一年後搜尋其手術病理組織記錄，將其病理報告和之前的細針穿刺病理診斷記錄比對，並計算細針穿刺細胞學檢查的敏感性(sensitivity)與特異性(specificity)。 結果：甲狀腺和乳房細針穿刺的不充足性抹片(inadequacy smear)比例各佔82.8%和69.5%，且所有假陰性(false negative)的診斷都是由不充足性群體中發現。在不同科別間其抹片的充足性比率呈現統計差異。我們也發現穿刺者(aspirators)執行細針穿刺的頻率愈高，所獲得的抹片的充足性愈高，且發現穿刺者採取的片數愈多，所抽取的抹片充足性也愈高。 結論：太多科別和穿刺者參予甲狀腺細針穿刺檢查，執行穿刺時製作抹片數或穿刺次數少，和某些穿刺者只是偶而執行穿刺是造成不充足抹片比例很高的原因。此外缺乏對穿刺者施以訓練和缺乏操作綱要也是主要的因素。

Abstract OBJECTIVE: To evaluate the smear adequacy of both thyroid and breast fine needle aspiration (FNA) by reviewing FNA slides at one medical center in Taiwan. STUDY DESIGN: A total of 503 thyroid and 316 breast FNA smears from April 1 to June 30, 2004 were selected and reviewed. A pathologist performed the FNA slide review to determine the smear adequacy according to the criteria of Kini and Layfield. Among the cases studied, those who were operated on before June 30, 2005 were further investigated to analyze the pathology results after operations compared with prior FNA diagnoses. The sensitivity and specificity of FNA examination were then calculated. RESULTS: A high percentage of inadequate smears were observed for both thyroid (82.8%) and breast (69.5%) FNAs, all presenting a false negative diagnosis in the inadequacy group. The smear adequacy rates were significantly different between different specialties. We also found that the higher the frequency of aspirations performed, the higher was the adequacy rate of aspirated smears. Moreover, the greater the number of slides prepared by aspirators, the higher was the smear adequacy rate. CONCLUSION: Many specialties and doctors are involved in thyroid FNA aspiration. A low number of slides prepared and passes taken during FNA aspiration, as well as infrequent and unskilled aspirators, are important factors for the low smear adequacy. Formal training for all aspirators and guidelines for FNA procedures are recommended in the hospital studied.