剪切波杨氏模量值在甲状腺结节良恶性诊断中的应用价值

Value of Young’s modulus of shear wave in the diagnosis of benign and malignant thyroid nodules

目的应用剪切波弹性成像测定甲状腺结节的杨氏模量值,探讨其在甲状腺结节良恶性鉴别诊断中的价值。方法 选取2016年8月—2017年8月在河北省人民医院超声科检查的甲状腺结节患者142例(152个结节)进行实时剪切波弹性成像。以手术病理学检查为“金标准”、甲状腺细针抽吸活检(FNA)细胞学检查+超声随访为参考标准,绘制ROC曲线,分析鉴别良、恶性病灶的参考界值。结果 甲状腺良、恶性结节杨氏模量的最大值、平均值比较差异均有统计学意义(t=-5.690、-5.439、-4.363、-4.804,P<0.05)。弹性模量最大值、平均值诊断甲状腺恶性结节的诊断截断值分别为42.86kPa、23.22kPa,ROC曲线下面积分别为0.768、0.743,诊断甲状腺良、恶性结节的敏感度分别为80.0%、75.4%,特异度分别为70.2%、71.4%,准确率分别为74.5%、73.1%。结论 剪切波弹性成像测得的甲状腺结节杨氏模量最大值及平均值可以定量评价病灶的硬度,有助于甲状腺结节良恶性的鉴别诊断,其中最大值具有更好的诊断价值。

Objective Shear wave elastography was used to determine the Young's modulus of thyroid nodules, and its value in the differential diagnosis of benign and malignant thyroid nodules was explored. Methods From August 2016 to August 2017, 142 patients (152 nodules) with thyroid nodules examined by ultrasound department of Hebei People's Hospital were selected for real-time shear wave elastography. The ROC curve was drawn to analyze the reference threshold value for differentiating benign and malignant lesions by using surgical pathology as the "gold standard" and fine needle aspiration biopsy (FNA) cytology plus ultrasound follow-up as the reference standard. Results The maximum and mean values of Young's modulus of benign and malignant thyroid nodules were statistically significant ( t =-5.690, t =-5.439, t =-4.363, t =-4.804 , P <0.05). The maximum cutoff value of the elastic modulus and the average value of the diagnosis of thyroid malignant nodules were 42.86 kPa and 23.22 kPa, respectively. The area under the ROC curve was 0.768 and 0.743, respectively. The sensitivity of diagnosis of thyroid and malignant nodules was 80.0% and 75.4%. The specificity was 70.2% and 71.4%, respectively, and the accuracy rates were 74.5% and 73.1%, respectively. Conclusion The maximum and average Young's modulus measured by shear wave elastography can quantitatively evaluate the hardness of thyroid nodules, which is helpful for differential diagnosis of benign and malignant thyroid nodules, and the maximum value has better diagnostic value.