超声联合硬度评分系统在甲状腺微小结节诊断中的应用价值

The value of combined stiffness score system for the diagnosis of thyroid micronodules

目的探讨超声联合硬度评定系统在甲状腺微小结节诊断中的应用价值。方法对30例行甲状腺切除手术患者的67个甲状腺微小结节,术前分别行实时弹性成像和声脉冲辐射力成像评定成像测定其硬度。在此基础上,以联合硬度评定系统对甲状腺结节硬度进行评定,以硬度为依据鉴别诊断甲状腺结节的良恶性,并以病理为标准,绘制ROC曲线。结果实时弹性成像鉴别诊断甲状腺良恶性的敏感度、特异度、阳性预测值、阴性预测值、准确性分别为58.8%、96.9%、95.2%、69.6%、77.6%。声脉冲辐射力成像鉴别诊断甲状腺良恶性的敏感度、特异度、阳性预测值、阴性预测值、准确性分别为76.4%、75.8%、76.4%、75.8%、76.1%。联合硬度评定系统鉴别诊断甲状腺良恶性的敏感度、特异度、阳性预测值、阴性预测值、准确性分别为91.2%、93.9%、93.9%、91.2%、92.5%。联合系统与实时弹性成像以及声脉冲辐射力成像相比,ROC曲线下面积分别为0.98,0.93和0.88(Z=8.72,P<0.05)。结论联合硬度评分系统有助于提高术前甲状腺微小结节良恶性鉴别诊断的准确性。

Objective To assess the value of combined stiffness score system（CSSS） in differential diagnosis of thyroid micronodules. Methods 30 patients with 67 thyroid nodules underwent real-time elastography（RTE） and acoustic radiation force impulse（ARFI） imaging before thyroidectomy, then CSSS were taken to re-evaluate the stiffness of the thyroid nodules. Compared with pathological findings, ROC curves were drawn to evaluate the diagnostic accuracy. Result The sensitivity, specificity, positive predictive value（PPV）, negative predictive value（NPV） and accuracy of RTE for differential diagnosis were 58.8%, 96.9%, 95.2%, 69.6%, 77.6%, while for ARFI and CSSS they were 76.4%, 75.8%, 76.4%, 75.8%, 76.1%, and 91.2%, 93.9%, 93.9%, 91.2%, 92.5%. The areas under the ROC curve for CSSS, RTE and ARFI were 0.98, 0.93 and 0.88 respectively, there were significant differences（Z = 8.72, P 〈0.05）. Conclusion CSSS was helpful in differential diagnosis of benign and malignant thyroid micronodules.