超声在意义不明确的细胞非典型病变甲状腺结节中的价值

Role of Thyroid Ultrasound in the Diagnosis of Thyroid Nodules with Atypia of Undetermined Significance

目的评估甲状腺超声在意义不明确的细胞非典型病变（AUS）中的临床价值。方法选取2014年1月至2015年12月在北京协和医院进行甲状腺细针穿刺患者1984例,其中细胞学诊断为AUS并有手术病理或临床随诊的病例83例,回顾分析83例甲状腺穿刺结节超声声像图资料,依据美国甲状腺协会推荐的超声图像进行分级：高度可疑恶性、中度可疑恶性、低度可疑恶性。结果 83例中手术证实恶性19例（22.9%）、良性8例（9.6%）,临床随诊无异常改变56例（67.5%）。单发结节36例（43.4%）、多发结节47例（56.6%）,结节最大径（1.2±0.7）cm。病理恶性19例中16例（84.2%）超声分级为高度可疑恶性,2例（10.5%）为中度可疑恶性,1例（5.3%）为低度可疑恶性。单因素及多因素分析显示甲状腺结节恶性程度与穿刺结节超声图像分级显著相关[OR=9.23（2.96～28.79）,P=0.00],但与患者的年龄、性别、结节数目及结节大小无关（P均〉0.05）。结论甲状腺超声图像分级有助于诊断为AUS甲状腺结节的良恶性判断。

Objective To evaluate the role of ultrasound for thyroid nodules with atypia of undetermined significance（ AUS）. Methods From January 2014 to December 2015,83 thyroid nodules with AUS diagnosed by ultrasound-guided fine-needle aspiration biopsy were collected from 1984 subjects. On the basis of ultrasonic features,each thyroid nodule was prospectively classified into one of three categories： low suspicion for malignancy,intermediate suspicion for malignancy,and high suspicion for malignancy. Results Among 83 lesions,19 lesions（ 22. 9%） were confirmed malignant,8 lesions（ 9. 6%） were benign,56 lesions（ 67. 5%）had no abnormal changes during clinical follow-up. The nodules were solitary in 36 cases（ 43. 4%） and multiple in 47 cases（ 56. 6%）. The maximum diameter was（ 1. 2 ± 0. 7） cm. Based on the ultrasonic feature of 19 malignant cases,16 cases（ 84. 2%） were classified as high suspicion for malignancy,2 cases（ 10. 5%） as inter-mediate suspicion for malignancy,and 1 case（ 5. 3%） for low suspicion for malignancy. Univariate and multivariate analyses revealed that the degree of malignancy of thyroid nodules was significantly associated with ultrasound image classification [OR = 9. 23（ 2. 96-28. 79）,P = 0. 00 ],but not with age,gender,nodule number,and nodule size（ all P〉0. 05）. Conclusion Ultrasound diagnosis by using the present thyroid ultrasound classification system can be helpful for distinguishing malignant and benign AUS thyroid nodules.