超声诊断指标量化评估甲状腺结节

Quantitative evaluation of thyroid nodules with ultrasonography

目的探讨超声鉴别诊断甲状腺结节良、恶性的价值,尝试建立量化分级系统。方法对1206例患者1329个甲状腺结节的14项超声特征进行评估,计算每项指标的OR值及其赋值,对每个结节进行综合评分,建立量化分级系统。结果超声诊断指标评分≤3分、4～5分、6～7分、8～9分、10～11分、12～13分、14～15分、16～17分、18～19分、20～21分、22～23分、24～25分、≥26分的各组中,恶性病灶构成比分别为0(0/309)、1.98%(4/202)、4.40%(7/159)、14.29%(11/77)、21.84%(19/87)、59.52%(25/42)、63.27%(31/49)、81.13%(43/53)、83.93%(47/56)、88.33%(53/60)、90.57%(48/53)、94.44%(51/54)、98.44%(126/128)。通过ROC曲线得出12分为区分良、恶性结节的最佳界点。根据以上两项结果,初步建立一个分级系统,共分为5级:1级:≤3分(恶性率0),2级:4～7分(恶性率1%～5%),3级:8～11分(恶性率6%～25%),4级:12～21分(恶性率26%～90%),5级:≥22分(恶性率≥90%)。结论量化分级系统使超声报告更加客观化、规范化和标准化,可用于临床评估甲状腺结节恶性风险度。

Objective To investigate the value of ultrasound in differential diagnosis of benign and malignant thyroid nodules, and to establish a quantitative grading system. Methods Fourteen ultrasound features of 1329 thyroid nodules in 1206 patients were examined and evaluated on preoperative ultrasonography. OR values were calculated for each indicator. Results The proportion of malignant lesions in scores 43, 4-5, 6 7, 8-9, 10 11, 12-13, 14 15, 16-17, 18 19, 20-21, 22 23, 24-25 and ≥26 points was 0 （0/309）, 1.98% （4/202）, 4.40% （7/159）, 14.29% （11/77）, 21.84% （19/87）, 59.52% （25/42）, 63.27% （31/49）, 81.13%（43/53）, 83.93% （47/56）, 88.33% （53/60）, 90.57% （48/53）, 94.44% （51/54） and 98.44% （126/128）, respectively. Point 12 was the best cutoff score by ROC analysis in differentiating benign and malignant nodules. A quantitative rating system was established according to mentioned results which included 5 grades： Grade 1：43 points （0 malignancy）, grade 2：4-7 points （1%-5% malignancy）, grade 3： 8- 11 points （6%-25% malignancy）, grade 4.. 12-21 points （26%-90% malignancy） and grade 5≥22 points （≥90% malignancy）. Conclusion The established quantitative grading system can make ultrasonic report objective and standardized. It is a viable method to evaluate the risk of malignant thyroid nodules.