超声造影在细胞学不能明确诊断的甲状腺结节中的应用

The diagnostic value of contrast enhanced ultrasound in thyroid nodules with an initial inconclusive diagnostic fine needle aspiration

目的:研究超声造影(CEUS)在最大径(L)<0.5 cm且首次细针穿刺(FNA)检查不能明确诊断的甲状腺结节中的应用价值。方法:回顾性分析2012年1月至2016年1月于浙江大学医学院附属第二医院就诊、超声怀疑恶性且L<0.5 cm并经过CEUS和2次FNA检查的61例患者的超声图像、数据及病理资料。61例患者共63个结节(其中2例为双侧结节),最后均经手术明确诊断。结果:CEUS和第2次FNA的恶性检出率(DROMN)、良性检出率(DROBN)、假阴性率(FNR)、假阳性率(FPR)、诊断准确率、不能明确诊断结节比率(PIDR)及其恶性比率分别为CEUS:84.8%、36.7%、15.3%、12.5%、86.7%、28.5%、16.7%;第2次FNA:24.2%、33.3%、41.2%、0.0%、72.0%、60.3%、47.4%。CEUS的DROMN明显高于第2次FNA,PIDR及恶性比率明显高于第2次FNA,差异均有统计学意义(均P<0.05)。结论:CEUS与第2次FNA相比,对第1次FNA不能明确诊断的且L<0.5 cm的甲状腺结节具有较高的诊断效能。

Objective： To evaluate the diagnostic value of the contrast enhanced ultrasound （CEUS） in the thyroid nodule less than 0.5 cm with an initial inconclusive diagnostic fine needle aspiration cytology （FNA）. Methods： A retrospective analysis of the clinical data of 61 patients was performed, including 63 thyroid nodules with L〈0.5 cm. All the thyroid nodules had an initial inconclusive diagnostic FNA and undergone CEUS, a repeat FNA after 3 months and finally confirmed by pathology. All the imaging data of preoperative FNAs and CEUS were collected. Pursuant to which, the detection rate of malignant nodules （DROMN）, the detection rate of begin nodules （DROBN）, the false negative rate （FNR）, the false positive rate （FPR）, the accuracy of diagnosis, the persistently inconclusive diagnostic rate （PIDR） and the malignant proportion by repeat FNA and CEUS were analyzed respectively. Results： In CEUS group, the DROMN, DROBN, FNR, FPR, the accuracy of diagnosis, PIDR and the malignant rate were 84.8%, 36.7%, 15.3%, 12.5%, 86.7%, 28.5% and 16.7% respectively. In the repeat FNA group, DROMN, DROBN, FNR, FPR, the accuracy of diagnosis, PIDR and the malignant proportion were 24.2%, 33.3%, 41.2%, 0.0%, 72.0%, 60.3%, 47.4%. The DROMN, PIDR and the malignant rate in the group CEUS were statistically higher than the repeat FNA group （P〈0.05）. Conclusion： CEUS has a better diagnostic efficiency in the thyroid nodule less than 0.5 cm with an initial inconclusive diagnostic FNA than the repeat FNA. The non-invasive CEUS examination can be suggested.