TI-RADS分级联合超声弹性成像诊断甲状腺微小乳头状癌价值研究

Value of combining TI-RADS and ultrasonic elastography in diagnosing papillary thyroid microcarcinoma

目的探讨甲状腺影像学报告及数据系统(TI-RADS)分级联合超声弹性成像(UE)在甲状腺微小乳头状癌(PTMC)术前诊断中的临床价值。方法回顾性分析2013年6月至2015年6月甘肃省肿瘤医院行超声检查的96例(138个恶性结节)PTMC病人和78例(142个微小良性结节)甲状腺病病人的临床资料。以病理学检查结果为金标准,比较TI-RADS分级、UE及两者联合诊断PTMC的敏感度、特异度、阳性预测值、阴性预测值及准确率。计算三种方法诊断PTMC的受试者工作特性(ROC)曲线下面积。根据结节直径将PTMC病人分为>5 mm组和≤5 mm组,比较各诊断方法的准确率。结果 TI-RADS分级联合UE诊断PTMC的敏感度、特异度、阳性预测值、阴性预测值及诊断准确率(93.5%、97.2%、97.0%、93.9%及95.4%)均高于UE(87.7%、93.7%、93.1%、88.7%及90.7%)和TI-RADS分级(80.4%、87.3%、86.0%、82.1%及83.9%)。TI-RADS分级、UE及二者联合诊断PTMC的ROC曲线下面积分别为0.873、0.937、0.972,UE的诊断价值高于TI-RADS分级(P<0.05),两种方法联合诊断价值高于单一方法(P<0.05)。三种方法对≤5 mm和>5 mm PTMC的诊断准确率分别为72.8%、90.1%、92.7%和89.9%、92.3%、97.2%,UE对于≤5 mm PTMC的诊断准确率明显高于TI-RADS分级(P<0.05)。结论 UE对PTMC的术前诊断价值高于TI-RADS分级,尤其对于≤5 mm的PTMC诊断准确率更高,二者联合有助于提高PTMC术前诊断准确率。

Objective To investigate the value of combination of thyroid imaging reporting and date system （TI-RADS） and ultrasonic elastography （UE） in preoperative diagnosis of papillary thyroid microcarcinoma （PTMC）. Methods The clinical data on 96 PTMC patients with 138 malignant nodules and 78 thyroid diseases patients with 142 benign micro-nodules in Gansu Provincial Cancer Hospital between June 2013 and June 2015 were analyzed retrospectively. The diagnosis capabilities indicators were estimated by taking pathological findings as gold standard to compare the value of TI-RADS, UE and their combination in the diagnosis of PTMC. The 138 malignant nodules of 96 PTMC patients were divided into two groups according to whether the diameter of nodules were greater than 5 mm or not. The diagnosis accuraties among TI-RADS, UE and combined application in two groups was compared. The receiver operating characteristic （ROC）curves of TI-RADS, UE and combined application of them were drawn. The area under the ROC curve were calculated. Results The sensitivity, specificity, positive predictive value, negative predictive value and diagnosis accuracy of TI-RADS plus UE （93.5%, 97.2%, 97.0%, 93.9% and 95.4% ）were higher than those of single method including UE （87.7%, 93.7%, 93.1%, 88.7% and 90.7% ） and TI-RADS （80.4%, 87.3%, 86.0%, 82.1% and 83.9% ）. The area under the ROC curve of TI-RADS, UE and their combination was 0.873, 0.937 and 0.972,respectively. The value of UE diagnosing PTMC was superior to that of TI-RADS （P〈0.05）, but both inferior to that of their combined application （P〈0.05）. Thediagnosis accuracy of TI-RADS, UE and their combination in diameters ≤5mm group and 〉 5mm group were 72.8%, 90.1%, 92.7% and 89.9%, 92.3%, 97.2%, respectively. In the nodule diameters≤5mm PTMC group, the diagnosis accuracy of UE was significantly higher than that of TI-RADS （P〈0.05）. Conclusion Diagnostic value of UE is better than TI-RADS in PTMC before operation, especially to the nodule diameters ≤5mm PTMC. The combination of both could improve the preoperative accuracy in diagnosing PTMC.