超声造影联合细针穿刺抽吸活检评价TI-RADS4类甲状腺结节良恶性的应用价值

目的探讨超声造影（CEUS）联合细针穿刺抽吸活检（FNA）在甲状腺超声影像报告和数据系统（TI-RADS）4类甲状腺结节良恶性鉴别诊断中的应用价值。方法回顾性分析98例甲状腺结节患者共103个TI-RADS类结节的常规超声检查、CEUS及FNA资料，与术后病理检查对照，评价CEUS、FNA及CEUS联合FNA鉴别甲状腺TI-RADS4类结节良恶性诊断中的敏感度（sensitivity）、特异度（specificity）以及阳性预测值（PPV）、阴性预测值（NPV）、准确性。结果CEUS、FNA对TI-RADS4类甲状腺结节的灵敏度、特异度、PPV、NPV和准确率分别为82．8％、897％、93％、76．1％、85．4％和85．9％、87．2％、94．8％、75．6％、883％，CEUS联合FNA的灵敏度、特异度、PPV、NPV和准确率分别为969％、87．2％、92．5％、94．4％、932％．两者联合应用的灵敏度、准确率均高于单项检查，差异有统计学意义（P〈0.05）。结论CEUS及FNA联合诊断TI-RADS 4类甲状腺结节的良恶性具有更佳的灵敏度，二者联合有助于提高诊断的准确性。

Objective To investigate the effects of contrast-enhanced ultrasound （ contrast-enhanced ultrasound, CEUS ） combined with fine needle aspiration biopsy （ fine needle aspiration biopsy, FNA ） in the differential diagnosis of benign and malignant thyroid no＆des with TI- RADS （ Thyroid Imaging Reporting and Data system, TI-RADS ） 4. Methods The routine ultrasound examination, CEUS and FNA data of 98 thyroid nodules with 103 TI-RADS 4 nodules were analyzed retrospectively. Compared with postoperative pathological examination, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CEUS, FNA and CEUS combined with FNA in the differential diagnosis of thyroid TI-RADS 4 nodules were evaluated. Results The sensitivity, specificity, NPV, PPV and accuracy of CEUS and FNA on TI-RADS 4 thyroid nodules were 82.8%, 89.7%, 93%, 76.1%, 85.4%and 85.9%, 87.2%, 94.8%, 75.6%, 88.3%, the sensitivity, specificity, PPV, NPVand accuracy of CEUS combined with FNA on TI-RADS a thyroid nodules were 96.9%, 87.2%, 92.5%, 94.4%, and 93.2%. The sensitivity and accuracy of combined application were higher than those of single examination, the differences were statistically significant （ P〈0.05 ） . Conclusion CEUS and FNA combined diagnosis of TI-RADS 4 thyroid nodules of benign and malignant has better sensitivity. The combination of the two is helpful to improve the accuracy of the diagnosis.