超声量化评分系统联合细针穿刺鉴别诊断甲状腺结节的临床分析

Ultrasonic quantification system combined with ultrasound-guide fine needle aspiration biopsy in the differential diagnosis of benign and malignant thyroid nodules:clinical analysis of 100 cases

目的探讨甲状腺超声量化评分系统联合超声引导下细针穿刺在鉴别甲状腺结节良恶性中的临床应用价值。方法回顾性分析2015年10月至2017年6月我院内分泌科收治的接受超声引导下细针穿刺且手术病理证实的100例甲状腺结节患者的超声声像图,分别对常规灰阶超声及多普勒超声显示的结节形状、回声强度、生长形状、钙化灶、光晕、回声结构、直径、边界、增长速度、颈部淋巴结等10项超声特征,按照超声量化评分表予以评分;超声引导下细针穿刺的细胞学结果采用贝塞斯达系统(Bethesda System)予以分级,以手术后病理结果为金标准,分别绘制超声量化评分系统、超声引导下细针穿刺及二者联合ROC曲线,比较三者的诊断价值。结果共纳入100例甲状腺结节患者,年龄20～73岁(45.29±11.70)岁,其中男性15例,女性85例。促甲状腺激素(thyroid stimulating hormone TSH)高于正常值的11例、低于正常值的5例、在正常范围内84例。超声量化评分系统、超声引导下细针穿刺及二者联合的ROC曲线下面积分别为0.783、0.740、0. 844。超声量化评分系统的最佳评分切点是2,即>2分诊断为恶性,<2分诊断为良性。诊断效能的灵敏度为84. 37%,特异度为55. 56%,阳性预测率为77.14%,阴性预测率为66. 67%。细针穿刺的最佳分类切点是3,即细胞学分级Ⅰ、Ⅱ、Ⅲ级为良性,Ⅳ、Ⅴ、Ⅵ级为恶性,诊断效能的敏感度为79.69%,特异度为61.11%,阳性预测率为78.46%,阴性预测率为62.86%。二者联合的诊断效能的敏感度为85.94%,特异度为77.78%,阳性预测率为87. 30%,阴性预测率为75.68%。结论超声量化评分系统联合细针穿刺对甲状腺结节良恶性的诊断效能高于单一一种诊断方法。超声量化评分和细针穿刺分级对甲状腺结节良恶性的联合诊断回归方程为Logit(P)=0.797×超声评分+0.600×细针穿刺分级-3.746,以0.4为截断点能获得最大的诊断效能。

ObjectiveTo explore the clinical value of ultrasonic quantification system in combination with ultrasoundguided fine needle aspiration biopsy （US-FNAB） in the differential diagnosis of benign and malignant thyroid nodules. MethodsThe ultrasonographic features of 100 patients with thyroid nodules and undergoing US-FNAB in our department from October 2015 to June 2017 were collected and retrospectively analyzed. Ten sonographic features including nodular shape, echo intensity, growth shape, calcifications, halo, echo structure, diameter, boundary, growth rate and neck lymph nodes by conventional gray-scale ultrasound and Doppler ultrasound examinations were analyzed and scored with ultrasonic quantification system. The cytological results of US-FNAB were graded with Bethesda system. The post-operative pathological results were regarded as gold standard. The receiver operating characteristic （ROC） curve of ultrasonic quantification system, US-FNAB and their combination were draw respectively to compare the diagnostic values of the 3 methods. ResultsThe 100 subjected patients were 15 males and 85 females and at a mean age of 45.29±11.70 （20-73） years. There were 11 cases with thyroid stimulating hormone （TSH） higher than normal value, 5 cases lower and 84 cases within the normal range. The area under ROC curve was 0.783, 0.740 and 0.844, respectively for the ultrasonic quantitation system, US-FNAB and their combination. The best cutoff point of ultrasonic quantitation system was 2, that is, the nodules of 〉2 points were diagnosed as malignant, while 〈2 points were diagnosed as benign. The sensitivity, specificity, positive predictive value and negative predictive value of the quantitation system was 84.37%, 55.56%, 77.14% and 66.67%. The best cutoff point of o US-FNAB was 3, indicating the nodules of cytological classification Ⅰ, Ⅱ and Ⅲ as benign, while of Ⅳ, Ⅴ and Ⅵ as malignant. The sensitivity, specificity, positive predictive value and negative predictive value was 79.69%, 61.11%, 78.46% and 62.86%, respectively, while was 85.94%, 77.78%, 87.30% and 75.68%, respectively when combined together. ConclusionThe diagnostic efficacy of ultrasonic quantitation system combined with US-FNAB is superior to either one of them for diagnosis of benign and malignant thyroid nodules. The Logit regression equation of the combination is （P）=0.797×ultrasonic score＋0.600×fine needle aspiration biopsy classification-3.746, with 0.4 as the cutoff point to achieve maximal efficiency for diagnosis.