甲状腺结节超声特征参数对细针穿刺诊断效能影响的分析

Analysis of diagnostic efficacy of fine-needle aspiration for ultrasonic parameters of thyroid nodules

目的 探讨甲状腺结节超声特征参数大小、钙化对超声引导下细针穿刺抽吸（ultrasound-guided fine-needle aspiration,US-FNA）诊断效能的影响。方法 回顾性分析2012~2014年行US-FNA的614例患者,根据结节最大径分为A组（≤5 mm）、B组（5~10 mm）、C组（〉10 mm）,以及根据钙化类型分为N组（无钙化）、Mi组（微钙化）、Ma组（粗钙化）。以Bethesda System评估US-FNA结果,同时应用受试者工作特征曲线（ROC）评价诊断效果。结果 1A组FNA诊断甲状腺癌敏感性、特异性、准确率、阳性预测值、阴性预测值分别为92.1%、96.6%、94.0%、97.2%、90.3%;B组分别为91.1%、95.3%、93.0%、96.3%、89.1%;C组分别为93.6%、96.2%、95.1%、94.8%、95.2%,3组间敏感性、特异性、准确率、阳性预测值、阴性预测值比较差异均无统计学意义（P〉0.05）。N组FNA诊断甲状腺癌敏感性、特异性、准确率、阳性预测值、阴性预测值分别为90.9%、96.3%、93.6%、96.3%、90.9%;Mi组分别为93.5%、92.1%、93.0%、95.1%、89.7%;Ma组分别为96.6%、97.1%、96.8%、96.6%、97.1%,3组间各值比较差异均无统计学意义（P〉0.05）。2A、B、C组的ROC曲线下面积AUC分别为0.94、0.93、0.95,N、Mi、Ma组分别为0.94、0.93、0.97。结论 US-FNA对于大小不限、有无钙化的甲状腺结节均具有较高的诊断价值。

Objective To investigate diagnostic effectiveness of uhrasound-guided fine-needle aspiration （US-FNA） for the sonographic features of thyroid nodules like size and calcification. Methods A retrospective analysis of the clinical patients of 614 thyroid nodules from 2012 to 2014. According to the maximal diameter of thyroid nodules, the nodules were divided into group A（≤5 mm）,B（5 -10 mm）,and C（ 〉 10 mm）,and according to the calcification,the nodules were divided into group N （ no calcification）, group Mi （Microcalcifieation） and group Ma （Macrocalcification）. By the Bethesda System, 〉 grade IV was the malignant cytologic criteria for diagnosis of thyroid nodules. At the same receiver operating characteristic curve was to evaluate the diagnosis of size and calcification between groups. Results （1）In group A,the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of US-FNA were 92.1% ,96.6%, 94.0% ,97.2% ,and 90.3%. In group B ,they were 91.1% ,95.3% ,93.0% ,96.3% ,and 89.1%. In group C,they were 93.6% ,96.2% ,95.1%, 94.8% and 95.2%, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the three groups showed no significant difference （ P 〉 0.05 ）. In group N, they were 93.6% ,96.4% ,93.6% ,96.3% and 90.9%. In group Mi,they were 89.5% ,88.9% ,93.0% ,95.1% and 89.7% ,and in group Ma,they were 96% ,97.1% ,96.8% ,96.6% and 97.1% ,respectively. The three groups also show no signifi- cant difference（P 〉0. 05 ）. （2）AUC of group A, B, and C were 0. 94, 0. 93, and 0.95, while group N, Mi, and Ma were 0.94,0.93, and 0. 97. Conclusion US-FNA is not limited to the size, calcification of thyroid nodules, but have high di- agnostic value.