超声量化评分鉴别诊断甲状腺良恶性占位病灶的临床价值

Clinical values of ultrasonic quantitative scores in differential diagnosis of benign and malignant thyroid space-occupying lesions

目的:探讨超声量化评分鉴别诊断甲状腺良恶性占位病灶的临床价值。方法:回顾性分析262例甲状腺占位性病变患者的临床资料,按甲状腺占位病变的良恶性分为对照组150例(163个良性病灶)和观察组112例(119个恶性病灶)。所有病灶均经病理组织学检查确诊,采用彩色多普勒超声全面扫查甲状腺及其周围淋巴结,按超声量化评分法进行评分;比较两组超声量化评分、钙化灶类型和阳性率;以病理检查为金标准,绘制受试者工作特征(Receiver operator characteristic curve,ROC)曲线,计算超声量化评分的ROC曲线下面积(Area under ROC curve,AUC)、最佳诊断阈值、灵敏度、特异性、阳性预测值、阴性预测值及诊断准确度。结果:(1)观察组病灶超声量化评分明显高于对照组,差异有统计学意义(P<0.01)。(2)超声量化评分的AUC为0.834,最佳诊断阈值为11.7分,灵敏度、特异性、阳性预测值、阴性预测值及诊断准确度分别为79.83%、82.82%、77.24%、84.91%及81.56%。(3)观察组病灶沙砾样钙化灶阳性率、钙化灶总阳性率均明显高于对照组,差异有统计学意义(P<0.01)。结论:超声量化评分鉴别诊断甲状腺良恶性占位病灶具有较高的临床价值,恶性占位病灶以沙砾样钙化灶常见。

Objective： To investigate clinical values of ultrasonic quantitative scores in differential diagnosis of benign and malignant thyroid space-occupying lesions. Methods： The clinical data of 262 cases of thyroid space-occupying lesions were analyzed retrospectively,and these patients were divided into control group（150 cases,163 benign lesions） and observation group（112 cases,119 malignant lesions） according to the benign or malignant lesions. All lesions were diagnosed by pathological examination,and the color Doppler ultrasound was used to scan the thyroid and peripheral lymph nodes,then the ultrasonic quantitative scores were evaluated. The ultrasonic quantitative scores,calcification type and positive rate were compared between the 2 groups. The pathological examination was defined as the gold standard,and the receiver operator characteristic（ROC） curve was drawn,and then the area under ROC curve（AUC）,best diagnostic threshold,sensitivity,specificity,positive predictive value,recessive predictive value and diagnostic accuracy of the ultrasonic quantitative scores were calculated. Results：（1） The ultrasonic quantitative scores of the observation group were obviously higher than those of control group,and the differences were statistically significant（P〈0.01）.（2） The AUC of THE ultrasonic quantitative scores was 0.834,and the best diagnostic threshold was 11.7 points,which had a sensitivity（SEN） of 97.83%,a specificity（SPE） of 82.82%,a positive predictive value of 77.24%,a negative predictive value of 84.91%,and a diagnostic accuracy of 81.56%.（3） The total positive rate of calcification and the positive rate of gravel calcification of the observation group were obviously higher than those of control group（P〈0.01）,and the differences were statistically significant（P〈0.01）. Conclusions： The ultrasonic quantitative scores in the differential diagnosis of benign and malignant thyroid lesions shows good clinical values,and the calcification is more common in malignant lesions,and it mainly is gravel calcification.