颈部淋巴结超声检查结合超声弹性成像在甲状腺结节诊断中的价值

Value of Cervical Lymph Node Ultrasound Examination and Ultrasound Elasticity Imaging in Diagnosis of Thyroid Nodules

目的探讨颈部淋巴结超声检查结合超声弹性成像的技术手段在甲状腺结节诊断中的价值。方法研究对象为2014年1月—2016年12月期间所有经该院手术或者超声检查下行穿刺活确诊为甲状腺结节的患者,对患者甲状腺结节行超声弹性成像并结合颈部淋巴结多普勒超声检查,对图像进行研究分析。结果弹性超声成像对恶性结节的正确诊断率为84.6%,对良性结节的正确诊断率94.0%,组间相比较,超声弹性成像对于诊断甲状腺结节的良恶性差异有统计学意义(P<0.05)。超声弹性成像对于诊断甲状腺结节的总体敏感度为(33/39:84.6%),特异性为(77/82:94.0%),诊断正确率为(110/121:91.0%),该次经颈淋巴结超声检查发现有转移特征的病例有64例,共95个淋巴结,经病理检查证实有恶性转移淋巴结的35例,无实质恶性淋巴结转移的29例,转移淋巴结存在纵横比<2的占89.1%,淋巴门消失的占84.4%,微钙化的占79.7%,囊性边占18.8%,周边型血流占93.4%,而未转移淋巴结分别为18.2%,21.2%,0.0%,0.0%,0.0%,差异有统计学意义(P<0.05);相比较单一的超声弹性成像,弹性成像评分3分、5分结合颈部淋巴结超声检查后诊断甲状腺结节良恶性的特异性和敏感性均提高(评分3分者为90.0%和87.5%,评分5分者为100%和94.7%),弹性成像评分4分结合颈部淋巴结超声检查后诊断甲状腺结节的良恶性的敏感性提高(94.5%),差异有统计学意义(P<0.05)。结论相比单一的超声弹性成像,结合颈部淋巴结超声检查后,患者甲状腺结节的良恶性判断的敏感性和特异性大大提高。

Objective To study the value of cervical lymph node ultrasound examination and ultrasound elasticity imaging in diagnosis of thyroid nodules. Methods The patients with thyroid nodules proved by operation or aspiration biopsy in our hospital from January 2014 to December 2016 were selected and the patients were given the ultrasound elasticity imaging and Doppler ultrasound examinations and the images were researched and analyzed. Results The accurate diagnosis rate of ultrasound elasticity imaging to the malignant nodules and benign nodules was respectively 84.6% and94.0%, and the difference was statistically significant(P<0.05), and the total sensitivity, specificity and accurate rate of ultrasound elasticity imaging in diagnosis of thyroid nodules were respectively(33/39: 4.6%),(77/82:94.0%) and(110/121:91.0%), and thee examination showed that there were 64 cases with metastasis features and there were 95 lymph nodes in total, and the pathological examination proved that there were 35 cases with malignant metastatic lymph nodes and29 cases without parenchymal malignant metastatic lymph nodes, and aspect ratio in metastatic lymph node< 2, 89.1%,disappearance of lymph node, 84.4%, micro-calcification, 79.7%, cystic boundary, 18.8%, peripheral blood flow,93.4%, non-metastatic lymph nodes 18.2%,21.2%,0.0%,0.0%,0.0%, and the differences were statistically significant,(P<0.05), and the specificity and sensitivity of elasticity imaging score(3 marks and 5 marks) combined with neck lymph node ultrasound examination in diagnosis of benign and malignant thyroid nodules were improved compared with those of single ultrasound elasticity imaging(3 marks: 90.0% and 87.5%, 5 marks: 100% and 94.7%), and the sensitivity of elasticity imaging score(4 marks) combined with neck lymph node ultrasound examination in diagnosis of benign and malignant thyroid nodules were improved(94.5%), and the difference was statistically significant(P <0.05).Conclusion The specificity and sensitivity of elasticity ultrasound imaging combined with neck lymph node ultrasound examination in diagnosis of benign and malignant thyroid nodules are improved compared with those of single elasticity ultrasound imaging.