臺灣博碩士論文加值系統

甲狀腺結節（Thyroid nodule, TN）在臨床上是常見的並且已經成為重要的臨床問題，約95％的甲狀腺癌為單個結節，不過甲狀腺結節惡性的機率少於15％。隨著國內甲狀腺癌的發生率增加，如何透過超音波導引甲狀腺結節細針抽吸及細胞學報告來診斷甲狀腺疾病是相當重要的。
傳統由非外科醫師包括放射科或內分泌科醫師執行經超音波導引甲狀腺結節細針抽吸(Fine needle aspiration, FNA)，近年來有越來越多訓練中的外科醫師（一般外科或頭頸外科醫師）運用超音波幫病患進行甲狀腺結節診斷，並參與甲狀腺結節患者的治療。液態薄層製備(liquid based preparation, LBP)與傳統抹片(Conventional smear, CS)細胞學方法相比，不受傳統抹片由人力製成的抹片因素的影響、讓細胞樣本更好保存，降低細胞不足的比率及可作進一步的染色，是取代傳統抹片最有競爭力的選擇之一。
本研究由本院臨床資料庫提供2015/5/1~2016/5/1期間，由非外科醫師施行超音波導引下甲狀腺抽吸合併使用傳統細胞抹片細胞學檢查的病患及2016/5/1~2017/5/1期間由頭頸外科醫師行超音波導引甲狀腺結節細針抽吸合併使用液態薄層製備細胞學檢查的病患。研究結果顯示，頭頸外科醫師行超音波導引甲狀腺結節細針抽吸合併使用液態薄層製備的無法診斷率較低；手術比率兩組無差異；敏感性、特異性及診斷率較高；偽陰性比率也較低。在分析造成術前術後診斷差異的原因，本研究發現較小的結節(小於2公分)、當超音波檢查發現為不止一顆結節、超音波特徵為有鈣化、囊性變化、邊緣不規則，及病理組織為非乳突癌(濾泡癌及分化不良癌)，和偽陰性的結果有關，故當術前符合愈多以上的特徵時，即使細胞學報告為惡性較低的結果，臨床醫師應較積極建議病人至少接受單側甲狀腺切除來排除惡性的可能，若病患無法接受，在1-2月內應再反覆作細針抽吸以避免偽陰性的結果。

Thyroid nodules (TN) are common and became an important clinical problem. About 95% of thyroid cancers are single nodule, but the chance of malignancy is less than 15%. With the increase in the incidence of thyroid cancer in Taiwan, it is important to diagnose thyroid disease through ultrasound-guided fine needle aspiration and cytology report.
Traditionally, non-surgeon physicians including radiologists or endocrinologists, performed ultrasound guided-fine needle aspiration through thyroid nodules. In recent years, more and more newly trained surgeons including general surgeons or head and neck surgeons have used ultrasound to treat thyroid diseases. Compared with the Conventional smear(CS) method, the Liquid-based preparation(LBP) cytology is not affected by the human factors, allows the samples to be better preserved, reduces the rate of non-diagnostic rate, and the sample can be used for cell block. It is the most competitive alternatives to replace Conventional smear till now.
This study collected data during the period by the clinical data bank of the hospital, including patients who received thyroid nodule aspiration by non-surgeon physicians performed ultrasound guided-fine needle aspiration with Conventional smear cytology during 2015/5/1~2016/5/1 and Head and neck surgeon performed ultrasound guided-fine needle aspiration with liquid-based preparation cytology during 2016/5/1~2017/5/1.
The results of our study showed that head and neck surgeons performed ultrasound guided-fine needle aspiration with liquid-based preparation cytology had lower non-diagnostic rate; the surgical rate was none significant between the two groups; the sensitivity and diagnostic rate were higher; the false negative rate was also lower. In the analysis of the causes of false negatives, we found that smaller nodules (less than 2 cm), ultrasound image revealed more than one nodule, calcification, cystic changes, ill-defined margins, and pathological proved non-papillary carcinoma may be associated with false-negative results. Therefore, we suggested the patient should receive more aggressive treatment plan including unilateral thyroidectomy or repeated fined needle aspiration within 1-2 months when the patients meet more than one feature as above before surgery to avoid false negative results.

摘 要 i
ABSTRACT ii
誌謝 iii
目錄 iv
表目錄 vi
圖目錄 vii
第一章　緒論 1
1.1 研究背景與動機 1
1.2 研究目的 3
第二章　文獻探討 4
2.1甲狀腺生理及解剖 4
2.2甲狀腺超音波導引細針抽吸 8
2.3超音波導引細針抽吸技術 10
2.4頭頸外科與非外科醫師 10
2.5 傳統細胞學抹片與液態薄層製備 14
第三章　研究方法 19
3.1研究資料 19
3.2研究設計 19
3.3統計方法 23
3.4本研究的限制 24
第四章　研究結果 25
4.1 分析原始資料之細胞學報告 25
4.2 甲狀腺結節病患手術比例 26
4.3兩組有手術病患基本資料 26
4.4依兩組有手術病患數據分別分析 28
4.5 以病理報告良惡性來分組 31
4.6 分析造成術前術後診斷差異之可能因素 35
第五章　討論 36
5.1 原始資料之細胞學報告 36
5.2 甲狀腺結節病患手術比例 37
5.3 兩組有手術病患之比較 37
5.4 分析兩組診斷比率 37
5.5依病理報告良惡性來分組 39
5.6造成術前術後診斷差異之可能因素 40
第六章　結論 41
參考文獻 43
1. 中文部分 43
2. 英文部分 44

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