甲状腺结节的超声诊断特征分析与研究

Analysis and study of ultrasonographic characteristics of thyroid nodules

目的探讨超声诊断甲状腺结节的声像特征及甲状腺影像报告及数据系统(TI-RADS)分级对甲状腺癌的诊断价值。方法选择南京医科大学附属淮安市第一医院2016年1～12月收治的347例甲状腺结节患者作为研究对象。根据术后病理诊断结果将其分为良性组(n=127)和恶性组(n=220)。观察比较两组超声影像表现。采用TI-RADS分级标准将研究对象分为1～5级,比较TI-RADS分级诊断结果和病理诊断结果。结果 347例患者中,TI-RADS 1级1例,TI-RADS 2级54例,TI-RADS 3级59例,TI-RADS 4a级51例,TI-RADS 4b级88例,TI-RADS 4c级68例,TI-RADS 5级26例。恶性组患者超声影像中存在形状不规则、边界不清楚、存在微钙化、血流信号丰富等特征,其比例均明显高于良性组,差异有统计学意义(P <0.05)。在347例患者中,如果以不确定性较大的4a级作为分界点,TI-RADS分级诊断甲状腺癌的特异性、敏感性、准确性分别为74.8%、91.4%、85.3%;如果排除掉不确定性较大的4a级,只考虑1～3级为良性病变,4b～5级为恶性病变,TI-RADS诊断甲状腺癌诊断的特异性、敏感性、准确性分别为91.3%、90.1%、90.1%。结论 TI-RADS分级诊断甲状腺癌的敏感性、特异性和准确性较高,TI-RADS分级的应用有助于临床医生对超声诊断意见的判读,制订合理的治疗方案,临床实用价值较高。

Objective To assess the value of ultrasonographic characteristics and thyroid imaging reporting and data system(TI-RADS)for qualitative diagnosis of thyroid nodules.Methods A total of 347 patients with thyroid nodules underwent surgical treatment in the Affiliated Huai′an No.1 Pecople′s Hospital of Nanjing Medical University from January to December 2016 were enrolled.All of the enrolled patients were divided into the benign group(n=127)and the malignant group(n=220)according to the postoperative pathological diagnosis results.The ultrasound imaging findings in the two groups were observed and compared.The patients were divided into 1 to 5 grades by TI-RADS classification standard,and the grading diagnosis results were compared with pathological diagnosis results.Results Of the 347 patients,there were 1 case of TI-RADS level 1,54 cases of TI-RADS level 2,59 cases of TI-RADS level 3,51 cases of TI-RADS level 4a,88 cases of TI-RADS level 4b,68 cases of TI-RADS level 4c,26 cases of TI-RADS level 5.Ultrasound images in the malignant group showed characteristics of irregular shape,unclear boundary,microcalcification,and abundant blood flow signals,the propotions of these characteristics were higher than those in the benign group,the differences were statistically significant(P<0.05).Among the 347 patients,using grade 4a as the criterion for classifying benign and malignant lesion,the specificity,sensitivity and accuracy of TI-RADS classification was 74.8%,91.4%and 85.3%,respectively;if only grade 1-3(representing benign lesion)and grade 4b-5(representing malignant lesion)were considered,with exclusion of the dubious grade 4a,the specificity,sensitivity and accuracy of TI-RADS classification was 91.3%,90.1%and 90.1%,respectively.Conclusion The sensitivity,specificity and accuracy of TI-RADS classification in diagnosis of thyroid cancer are high.The application of TI-RADS classification is helpful for clinicians to interpret the diagnostic evaluation of ultrasound and thereby to make a reasonable treatment plan.So it has great clinical practical value.