通过分析超声科6名医师甲状腺结节超声引导下细针穿刺活组织检查（US-FNAB）的学习曲线，探讨US-FNAB初学者达到平均水平且相对稳定时所需的训练量，从而指导科室有效管控初学者甲状腺结节US-FNAB的穿刺质量。

选取2011年3月至2014年11月四川大学华西医院超声科6名穿刺医师（Dr1~Dr6）行US-FNAB的甲状腺结节6147例（其中Dr1和Dr6为有经验穿刺医师；Dr2~Dr5为穿刺初学者），收集其细胞病理学结果。并按结节的穿刺时间排序，从第1例结节开始，每100例为一组，依次进行分组。根据Bethesda分类标准将结节细胞病理学结果分为穿刺无效和穿刺有效2类，统计每一位医师每一组的穿刺无效率，绘制学习曲线。统计6名医师6147例甲状腺结节穿刺无效率的平均值。按照甲状腺结节的穿刺时间排序，统计Dr2~Dr5每名初学者第一个100例（F100）和第二个100例（S100）的穿刺无效率。采用四格表的χ²检验，将Dr2~Dr5每名初学者的F100和S100的穿刺无效率分别与6147例甲状腺结节穿刺无效率的平均值进行比较。

Dr1~Dr6每名医师每组穿刺无效率分别为：Dr1（17组）：25%、23%、17%、17%、14%、15%、24%、14%、12%、7%、8%、9%、6%、10%、11%、16%、8%；Dr2（5组）：40%、27%、24%、21%、13%；Dr3（10组）：22%、9%、20%、23%、13%、17%、14%、11%、10%、15%；Dr4（15组）：21%、22%、28%、26%、22%、29%、24%、19%、14%、20%、8%、11%、11%、9%、4%；Dr5（8组）：39%、24%、13%、21%、12%、13%、8%、9%；Dr6（4组）：13%、15%、5%、9%。由此绘制学习曲线。6名医师6147例甲状腺结节穿刺无效率的平均值为16.04%。Dr2~Dr5每名初学者F100和S100的穿刺无效率分别为：Dr2：40%，27%；Dr3：22%，9%；Dr4：21%，22%；Dr5：39%，24%。Dr2~Dr5每名初学者F100穿刺无效率和平均值的比较，差异有统计学意义的为Dr2（χ²=14.286，P<0.001）和Dr5（χ²=13.266，P<0.001），S100穿刺无效率和平均值的比较中，差异均无统计学意义（P均>0.05）。

绘制甲状腺结节US-FNAB初学者学习曲线，探讨其学习曲线规律，分析其达到平均穿刺水平且相对稳定时的训练量，从而准确判断初学者能够独立操作的时机，是初学者甲状腺结节US-FNAB质量控制的有效方法。

By analyzing the learning curve of ultrasound-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules that was conducted by six doctors at the ultrasound department, we aimed to obtain the number of cases that beginners need to perform to achieve the average and stable level of US-FNAB, so as to effectively control the quality of US-FNAB of thyroid nodules.

A total of 6147 thyroid nodules that underwent US-FNAB (performed by 6 doctors; Dr1 and Dr6 were experienced doctors, and Dr2-Dr5 were inexperienced doctors) were retrospectively studied between March 2011 and November 2014 at West China Hospital, Sichuan University. To evaluate the operator's diagnostic inadequacy over time, the procedures were chronologically subdivided into several consecutive groups of 100 cases each. Yields of US-FNAB were divided into two levels according to the classification standard of the Bethesda system: adequacy and inadequacy. The learning curve was plotted based on the inadequate diagnostic rate of US-FNAB according to every group data of each doctor. The average rate of diagnostic inadequacy for the 6147 thyroid nodules was analyzed. Then, the inadequate diagnostic rates for the first 100 (F100) and second 100 cases (S100) for each doctor from Dr2 to Dr5 was analyzed, respectively. Pearson Chi-Square test was used to compare the inadequate diagnostic rate between the average rate of diagnostic inadequacy for the 6147 thyroid nodules and the F100 and S100 of four doctors (Dr2-Dr5), respectively.

The rates of non-diagnostic procedures for each group from Dr1 to Dr6 were: Dr1 (17 groups): 25%, 23%, 17%, 17%, 14%, 15%, 24%, 14%, 12%, 7%, 8%, 9%, 6%, 10%, 11%, 16%, and 8%; Dr2 (5 groups): 40%, 27%, 24%, 21%, and 13%; Dr3 (10 groups): 22%, 9%, 20%, 23%, 13%, 17%, 14%, 11%, 10%, and 15%; Dr4 (15 groups): 21%, 22%, 28%, 26%, 22%, 29%, 24%, 19%, 14%, 20%, 8%, 11%, 11%, 9%, and 4%; Dr5 (8 groups): 39%, 24%, 13%, 21%, 12%, 13%, 8%, and 9%; Dr6 (4 groups): 13%, 15%, 5%, and 9%. The average rate of diagnostic inadequacy for the 6147 thyroid nodules was 16.04%. The inadequate diagnostic rates of the F100 cases and the S100 cases for each doctor from Dr2 to Dr5 were: Dr2: 40% and 27%; Dr3: 22% and 9%; Dr4: 21% and 22%; Dr5: 39% and 24%. The inadequacy rate of the F100 cases in Dr2 and Dr5 was significantly higher than the average rate of diagnostic inadequacy for the 6147 thyroid nodules (Dr2: χ²=14.286, P<0.001; Dr5: χ²=13.266, P<0.001). There was no difference in inadequate diagnostic rates between the S100 cases in each doctor from Dr2 to Dr5 and the average rate of diagnostic inadequacy for the 6147 thyroid nodules (P>0.05).

The learning curve of US-FNAB of thyroid nodules for beginners has been drawn and observed. According to the training amount that beginners require to achieve the average and stable level of US-FNAB, we can determine the time accurately when beginners could perform US-FNAB of thyroid nodules independently. In this way, we can get an effective method to manage the quality of US-FNAB of thyroid nodules.