超声检查各项诊断指标与甲状腺良恶性结节相关性的研究

Study of correlation between ultrasonic diagnostic indexes and benign and malignant thyroid nodules

目的探讨超声检查各项诊断指标在判断甲状腺良恶性结节中的应用价值。方法回顾性分析行彩色多普勒超声检查,并经穿刺及手术病理证实261例患者287个甲状腺结节的各项超声诊断指标(包括数量、边界、边缘、纵横比、内部回声、钙化、血流、颈部淋巴结有无转移等),并与穿刺及手术病理结果进行比较。所有结节根据病理结果分成良性组和恶性组,分析超声指标在鉴别甲状腺结节良恶性方面的作用。结果 287个结节中良性结节213个,占74.2%(213/287);恶性结节74个,占25.8%(74/287)。结节的单发、边界不清、边缘不规则、纵横比≥1、低回声、微钙化在诊断甲状腺恶性结节时的效能较高,与良性结节相比差异均有统计学意义(P<0.05)。其中单发在诊断恶性结节时敏感性为63.5%,特异性为90.1%,准确性为83.3%;边界不清在诊断恶性结节时敏感性为71.6%,特异性为87.8%,准确性为83.6%;边缘不规则在诊断恶性结节时敏感性为68.9%,特异性为79.8%,准确性为77.0%;纵横比在诊断恶性结节时敏感性为75.7%,特异性为91.1%,准确性为87.1%;低回声及极低回声在诊断恶性结节时敏感性为81.1%,特异性为60.0%,准确性为65.5%;微钙化在诊断恶性结节时敏感性为77.0%,特异性为90.1%,准确性为86.7%。结论超声在鉴别诊断甲状腺良恶性结节方面,有较高的应用价值。

Objective To discuss the diagnostic value of ultrasonography in benign and malignant thyroid nodules. Methods 261 patients were selected by biopsy and pathology, the ultrasound diagnosis indicators of 287 thyroid nodules （including the number, aspect ratio, border, internal echo, calcification, blood flow, cervical lymph node metastasis） were compared with the results of puncture and operation. All nodules were divided into benign and malignant groups according to pathological findings. Statistical methods were used to analyze the role of ultrasound in differentiating benign and malignant thyroid nodules. Results Among the 287 nodules,213 cases were benign nodules accounting for 74.2% （213/287） and 74 malignant nodules accounting for 25.8% （74/287）. Solitary nodules, unclear boundary, irregular edge ,aspect ratio is more than 1 ,low echo ,calcification in diagnosis of thyroid malignant nodules at high efficiency, compared with benign nodules showed significant differences （ P 〈 0.05 ）. The sensitivity in the diagnosis of malignant solitary nodules was 63.5%, the specificity was 90.1% ,the accuracy was 83.3% ;the sensitivity boundary of blurring in the diagnosis of malignant nodules was 71.6% ,the specificity was 87.8% ,the accuracy was 83.6% ;irregular edge sensitivity of 68.9% and specificity in the diagnosis of malignant nodules was 79.8%, the accuracy was 77% ; the aspect ratio of the sensitivity in the diagnosis of malignant nodules was 75.7% ,the specificity was 91.1% ,the accuracy was 87.1% ;the sensitivity of low echo -level and very low echo -level in the diagnosis of malignant nodules was 81.1% ,the specificity was 60% ,the accuracy was 65.5% ;the sensitivity of micro calcification in the diagnosis of malignant nodules was 77% ,the specificity was 90.1% ,the accuracy 86.7%. Conclusion Ultrasonography is of high value in differential diagnosis of benign and malignant thyroid nodules.