超声检查对桥本甲状腺炎伴发结节良恶性的鉴别诊断价值

Diagnostic value of ultrasonography in differentiating malignant and benign nodules of Hashimoto's thyroiditis

目的分析桥本甲状腺炎(HT)伴发结节的声像图特征,探讨超声弹性成像技术(UE)的甲状腺影像学报告及数据系统(TI-RADS)对甲状腺结节的定性诊断价值。方法选取87例HT伴发结节患者共1 39个结节(恶性73个、良性66个),行常规超声及UE检查,对所有甲状腺结节进行TI-RADS分类,并按照UE改良5分法进行评分,结合UE结果对TI-RADS分类进行调整,得到新的分类方法。以病理结果为金标准,评价不同分类方法对甲状腺结节的鉴别诊断价值。结果 TI-RADS分类诊断恶性结节的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为89.04%、87.88%、88.49%、89.04%、87.88%,UE评分的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为63.01%、93.94%、77.70%、92.00%、69.66%,结合UE评分的改良TI-RADS分类的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为97.26%、87.88%、92.81%、89.87%、96.67%,3种方法间比较均有统计学差异(均P<0.05)。结论在HT伴发结节的良、恶性鉴别中,TI-RADS分类的准确性高于UE,而改良TI-RADS分类能提高恶性结节的检出率。

Objective To evaluate the combined application of ultrasonography （US）, ultrasound elastography（UE） and Thyroid Imaging Reporting and Data System （TI-RADS） in differential diagnosis of malignant and benign nodules of Hashimoto＇s thyroiditis （HT）. Methods Eighty seven HT patients with 139 thyroid nodules （73 malignant, 66 benign） under- went conventional UT and UE examination. The nodules were analyzed with TI-RADS and classified with UE five-grade method; a new sorting system was developed based on the combination of TI-RADS with UE results. The pathological results were used as gold standard to evaluate the diagnostic value in differentiating malignant and benign HT nodules of different methods. Results The sensibility of TI-RADS, UE and TI-RADS with UE for diagnose of malignant nodules was 89.04%, 63.01% and 97.26%, respectively; specificity was 87.88%, 93.94% and 87.88%, respectively; the accurate rate was 88.49%, 77.70% and 92.81%, respectively; the positive predicted value was 89.04%, 92.00% and 89.87%, respectively; and the nega- tive predicted value was 87.88%, 69.66% and 96.67%, respectively （P〈0.05）. Conclusion In differential diagnosis of malig- nant HT nodules from benign, TI-RADS is more accurate than UE, and the combination TI-RADS with EU can further increase the diagnostic accuracy.