灰阶超声评分鉴别甲状腺良恶性结节的实用价值

The utility of gray-scale ultrasound scoring for the discrimination of benign and malignant thyroid nodules

目的评估灰阶超声评分鉴别甲状腺良恶性结节的实用价值。方法 498例(男102例,女396例)患者经细针抽吸活组织检查或术后病理证实的653个甲状腺结节,术前均接受颈部超声检查。根据结节的灰阶超声特征(纵横比、边界、周边声晕、内部回声、内部结构、后方回声衰减、微小钙化、结节突破甲状腺包膜和可疑颈部淋巴结)进行评分。利用ROC曲线分析超声得分鉴别结节良恶性的最佳临界值。结果 653个结节中,86例恶性(乳头状癌79例,滤泡状癌4例,髓样癌3例);567例良性(结节性甲状腺肿440例,腺瘤116例,亚急性甲状腺炎11例)。良性结节的平均超声得分为(1.3±1.0)分,恶性结节为(4.4±1.2)分(P<0.001)。ROC曲线分析超声得分鉴别结节良恶性的最佳临界值为4分(AUC:0.921),以超声得分≥4分诊断结节恶性的敏感性、特异性、阳性预测值、阴性预测值及诊断准确性分别为:88.4%、95.4%、74.5%、98.2%和94.5%。结论灰阶超声评分有助于判断甲状腺结节的良恶性,评分值越高,结节恶性的可能性越大。

[ Objective ] To evaluate the utility of gray-scale ultrasound （US） scoring for the discrimination of benign and malignant thyroid nodules. [Methods ] Preoperative cervical US was performed in 498 patients （102 male, 396 female） with 653 thyroid nodules confirmed by pathology post surgery, or fine-needle aspiration biopsy （FNAB）. All of nodules were scored according to the presence and absence of each gray-scale US feature （taller-than-wide shape, ill-defined margins, peripheral halo, hypoechoic, non-cystic composition, astern echoes attenuation, microcalcification, breakthrough thyroid envelope and suspicious cervical lymph node）. The cut off value of US scoring in the discrimination of benign and malignant nodules was analyzed using ROC analysis. [Results] All of 653 nodules include 86 malignant nodules （papillary carcinoma in 79, follicular carcinoma in 4 and medullary carcinoma in 3 cases） and 567 benign nodules （nodular goiter in 440, thyroid adenoma in 116 and granulomatous thyroiditis in 11 cases）. Mean US scoring in benign and malignant nodules was （1.3±1.0） and （4.4±1.2）, respectively （P 〈0.001）. The cut off value of US scoring at maximum sensitivity and specificity for nodules was four （AUC： 0.921）, leading to the sensitivity, specificity, positive predictive value and negative predictive value, and accuracy of 88.4%, 95.4%, 74.5%, 98.2%, 94.5%, respectively. [ Conclusion] The gray-scale US scoring of thyroid nodules helps evaluate the nature of the nodules, and a higher score suggests increased probability of malignancy.