术前超声及TSH检查对甲状腺结节性质诊断价值

THE VALUE OF PREOPERATIVE ULTRASONOGRAPHY AND SERUM THYROTROPIN DETECTION IN DIAGNOSING THYROID NODULES

目的探讨术前超声检查及血清促甲状腺激素（TSH）水平对甲状腺结节良恶性的诊断价值。方法回顾性分析了1499例甲状腺结节手术病人术前甲状腺超声表现、血清TSH水平、术后病理诊断报告，根据术后病理诊断分为甲状腺结节良、恶性组，比较两组病人超声声像特征及血清TSH水平的差异。结果分化型甲状腺癌（DTC）病人472例，其超声特征纵横比≥1、低回声、边界不清、形态不规则、微钙化、血流信号丰富的比例明显高于良性结节组，差异有显著性（χ2=253．21～398．08，P〈0．01）；以上超声特征诊断DTC的灵敏度为53．81％～76．06％，特异度70．79％～92．31％，阳性预测值为54．48％～76．28％，准确率为72．18％～80．19％，其中微钙化的特异度、阳性预测值最高。以病理诊断为标准，术前超声判断DTC的准确率为83．26％，诊断甲状腺结节良、恶性总的准确率为86．59％。DTC病人术前血清TSH水平明显高于甲状腺良性结节组，且肿瘤直径〉1cm较≤1CIll的病人血清TsH明显升高，差异有显著性（￡=38．89、7．23，P〈0.01）。结论术前超声检查和血清TSH水平检测有助于鉴别和预测甲状腺结节的良、恶性；超声特征结合血清TSH水平升高对甲状腺癌有重要的诊断价值。

Objective To evaluate the value of preoperative ultrasonography and serum thyroid stimulating hormone （TSH） detection in the diagnosis of benign and malignant thyroid nodules. Methods A retrospective analysis was done in 1 499 patients underwent surgery for thyroid nodules. The items analyzed including preoperative ultrasonographic manefestations, serum TSH levels, and postoperative pathologic reports. The patients were divided into benign-nodule group and malignant-nodule group according to postoperative pathologic diagnosis. A comparison was made between the two groups in regard to ultrasonic features and serum TSH levels. Results Differentiated thyroid carcinoma （DTC） was recorded in 472 cases, the ultrasonic features were as follows： A/T ~1, low echo-level, obscure boundary, irregular shape, microcalcification, and the percentage of rich blood flow signal was higher than that in the benign-nodule group （χ2 = 253.21 -- 398.08, P〈0.05）. The sensitivity of above ultrasonic features in the diagnosis of DTC was 53.81% --76.06%, specificity was 70.79% --92.31%, positive predictive value was 54.48%-76.28%, and accuracy rate was 72.18 %- 80.19%, of which, the specificity of microcaleification had the highest positive predictive value. Based on pathological diagnosis, the accuracy of preoperative ultrasonography for DTC was 83.26%, the overall accuracy of diagno- sing benign and malignant thyroid nodules was 86.59%. The preoperative serum TSH levels in DTC was significantly higher than that in benign-nodule group, when the tumor diameter 〉1 era, the TSH levels were much higher than that of ≤1 cm （t = 38.89, 7.23;P（0.01）. Conclusion Preoperative ultrasonography and serum TSH level detection conduce to identifying and predicting benign and malignant thyroid nodules, ultrasonic characteristics combined with elevated serum TSH levels has a great value in the diagnosis of thyroid carcinoma.