PTMC甲状腺外侵犯诊断中高分辨率超声的诊断价值研究

Diagnostic value of high-resolution ultrasonography in diagnosis of papillary thyroid microcarcinoma with extrathyroidal invasion

目的探讨甲状腺微小乳头状癌(PTMC)甲状腺外侵犯诊断中高分辨率超声的诊断价值。方法甲状腺肿瘤患者259例,结节直径≤1 cm,以病理检查为金标准,比较常规二维超声诊断PTMC的敏感度和特异度,并应用高分辨率超声检测患者包块与甲状腺被膜关系,并将有甲状腺被膜接触的患者根据其接触程度分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级,分析结节与被膜接触程度和甲状腺外侵犯的相关性。结果经手术或病理证实92例患者为PTMC,共108个结节;167例患者为甲状腺良性病变,共179个结节。以病理检查为金标准,超声诊断PTMC的敏感度为91.67%,特异度为94.41%,准确度为93.38%。当PTMC与相邻的甲状腺被膜有密切接触时,其对甲状腺外侵犯率明显增加,差异有统计学意义(P<0.05),分别以Ⅰ、Ⅱ、Ⅲ、Ⅳ级被膜接触程度为高分辨率超声诊断PTMC甲状腺外侵犯的标准,其ROC曲线下面积分别为0.744(0.649,0.840)、0.806(0.717,0.895)、0.624(0.514,0.733)、0.578(0.466,0.689),Ⅱ级与甲状腺被膜接触≥20%作为诊断标准的价值最大。结论高分辨率超声诊断PTMC甲状腺外侵犯的敏感度和特异度高,且以结节与甲状腺被膜接触≥20%作为诊断标准的应用价值最高,值得在临床PTMC甲状腺外侵诊断中应用。

Objective To evaluate the diagnostic value of high-resolution ultrasonography in the diagnosis of papillary thyroid microcarcinoma（ PTMC） with extrathyroidal invasion. Methods A total of 259 patients who had thyroid tumor with nodular diameter ≤1 cm were enrolled in this study. Taking pathological examination as gold standard,the sensitivity and specificity of conventional two-dimensional ultrasonography in diagnosis of PTCM were compared, and high-resolution ultrasonography examnation results were used to analyze the relationship between the masses and the thyroid capsule. In addition,the patients with thyroid tumors were divided into grades Ⅰ、Ⅱ、Ⅲ,and Ⅳ according to the contact extent with fibrous capsule of thyroid gland. The correlation between contact extent with fibrous capsule of thyroid gland and extrathyroidal invasion was analyzed. Results A total of 92 patients were surgically or pathologically confirmed as PTMC（ 108 nodules）,and 167 patients were confirmed as benign thyroid lesions（ 179 nodules）. Taking pathological examination as gold standard,the sensitivity,specificity and accuracy of ultrasonography in diagnosis of PTMC was 91. 67%,94. 41% and 93. 38%,respectively. When the PTMC was in close contact with the adjacent thyroid capsule,the extrathyroidal invasion rate was significantly increased（ P 〈 0. 05）. The grade Ⅰ、Ⅱ、Ⅲ,and Ⅳ contact extent with the capsule were used as diagnostic criteria for PTMC with extrathyroidal invasion,the area under ROC curve was 0. 744（ 0. 649,0. 840）,0. 806（ 0. 717,0. 895）,0. 624（ 0. 514,0. 733）,and 0. 578（ 0. 466,0. 689）,respectively. Therefore,the area of contact with thyroid gland ≥ 20%（ Grade Ⅱ） had the greatest value as a diagnostic criterion. Conclusion The sensitivity and specificity of high-resolution ultrasonography in diagnosis of PTMC with extrathyroidal invasion are higher,and the contact area with fibrous capsule of thyroid gland ≥ 20% is of the highest application value,therefore,which is worthy of application in clinical diagnosis of PTMC with extrathyroidal invasion.