SWE联合ATA(2015)指南超声模式在Bethesda Ⅲ类甲状腺结节中的应用价值

The role of SWE and ATA(2015) guidelines combined mode in differentiation malignant from benign of Bethesda Ⅲ thyroid nodules

目的:探讨第3代剪切波弹性成像技术(SWE)、ATA(2015)及SWE+ATA(2015)3种模式对性质不明确的甲状腺结节的诊断效能,明确超声在BethesdaⅢ类甲状腺良恶性结节鉴别中的诊断价值。方法:选取甲状腺细针穿刺细胞学检查(FNAB)诊断为意义不明确的细胞非典型性病变(AUS)/滤泡性病变(FLUS)的216例甲状腺结节作为研究对象,分析比较AUS/FLUS类结节的临床资料及二维超声特征,根据ATA(2015)超声指南分级标准对所有结节的二维超声图像进行分级,在新型声触诊组织成像定量剪切波弹性成像技术(VTIQ)模式下测量病灶内部横向剪切波速度(SWV),获取SWV的最大值(SWVmax)和平均值(SWVmean)。使用受试者工作特征曲线计算单一模式和联合模式鉴别甲状腺结节良恶性的最佳诊断界点,并根据诊断界点得出诊断效能等指标。结果:(1)在AUS/FLUS良恶性结节之间,患者的年龄、性别及结节的大小差异无统计学意义(P>0.05),152例AUS类结节多表现为不规则边界和微钙化且差异有统计学意义(P=0.005,P=0.004);(2)ATA(2015)指南超声模式对AUS类结节的良恶性评估有统计学意义(P=0.001),对FLUS类结节的良恶性鉴别未见明显统计学意义;(3)AUS/FLUS类结节的SWVmax和SWVmean值对结节良恶性的鉴别有统计学意义;(4)使用ATA(2015)+SWE联合模式诊断AUS类甲状腺结节的良恶性,得到曲线下面积为0.912大于单一诊断模式[ATA(2015):0.854,SWE:0.862],说明联合模式的诊断效能高于单一诊断模式。结论:SWE不仅能够弥补ATA(2015)在FLUS类甲状腺结节良恶性诊断中的不足,而且能有效提高ATA(2015)在AUS类甲状腺结节良恶性鉴别中的诊断效能。

Objective：To evaluate the diagnostic value of the ATA（2015）ultrasound model,shear wave elastography（SWE）,and ATA（2015）＋SWE combinative modality for the diagnostic efficiency in thyroid nodules with Bethesda Classification Ⅲ indeterminate cytology,determine the diagnostic value of ultrasonography in Bethesda Classification Ⅲ indeterminate cytology.Method：216 thyroid nodules that were initially diagnosed as AUS/FLUS by fine needle aspiration（FNA）were included in this study.The clinical data and two-dimensional ultrasonographic features were compared between the benign and malignant nodules.The two-dimensional ultrasound images of all nodules were sorted by the 2015 ATA guideline ultrasound model grading criteria.The maximum and average shear wave velocity（SWV）values were obtained from multiple SWV measurement under the VTIQ speed mode.The optimal threshold drawing from ROC curve and diagnostic performance of single and combinative modality were calculated.Result：（1）There was no significant difference in age,sex and nodule size between benign and malignant nodules（P〉0.05）.Malignant nodules of 152 cases of AUS thyroid nodules had significantly higher rates of not well-circumscribed margin and presence of microcalcifications（P=0.005,P=0.004）.（2）There were significant differences in malignancy risk among the different US patterns defined by the 2015 ATA guidelines in AUS nodules.（3）The maximum and mean SWV of AUS/FLUS nodules measured in VTIQ mode were statistically significant in evaluating benign and malignant nodules.（4）The area under ROC curves of ATA（2015）＋SWE combined mode was 0.912,larger than single diagnosis mode[ATA（2015）：0.854,SWE：0.862].Conclusion：SWE can not only compensate for the deficiency of ATA（2015）in the diagnosis of benign and malignant FLUS thyroid nodules,but also effectively improve the diagnostic performance of ATA（2015）in the differentiation of benign and malignant AUS thyroid nodules.