常规超声及应变弹性成像对细胞学结果不确定甲状腺结节的诊断价值

Value of conventional ultrasound and strain elastography in cytological diagnosis of indeterminate thyroid nodules

目的探讨常规超声和应变弹性成像对细胞学结果不确定(IC)甲状腺结节良恶性的鉴别诊断价值。方法选取我院经病理结果证实且细胞学诊断为IC的甲状腺结节135个(BethesdaⅢ、Ⅳ、Ⅴ类),其中恶性结节112个,良性结节23个,比较二者常规超声及弹性成像特征;通过Logistic回归分析分别构建恶性结节的常规超声预测模型及常规超声+细胞学结果预测模型;计算常规超声、常规超声+细胞学结果、常规超声+应变弹性成像及常规超声+细胞学结果+应变弹性成像四组模型判断IC甲状腺结节良恶性的敏感性、特异性、准确率、阳性预测值及阴性预测值;并绘制相应的受试者工作特征(ROC)曲线,计算曲线下面积,比较其诊断效能。结果良恶性IC结节在组成、纵横比、边界、血流分布、弹性评分方面比较差异均有统计学意义(均P<0.05)。常规超声、常规超声+细胞学结果、常规超声+应变弹性成像及常规超声+细胞学结果+应变弹性成像的ROC曲线下面积分别为0.760、0.784、0.643及0.660。常规超声+细胞学结果诊断恶性结节效能最优,其敏感性、特异性、准确率、阳性预测值及阴性预测值分别为74.11%、82.61%、75.56%、95.40%及39.58%,常规超声+应变弹性成像诊断恶性结节的敏感性最高,为98.21%;常规超声+细胞学诊断恶性结节的特异性最高,为82.61%。结论常规超声及应变弹性成像在鉴别IC甲状腺结节良恶性方面有一定价值;常规超声联合应变弹性成像诊断恶性结节的敏感性提高,但特异性降低,诊断效能未提高。

ObjectiveTo evaluate the diagnostic value of conventional ultrasound and strain elastography in thyroidnodules with indeterminate cytologic(IC)findings.MethodsA total of 135 thyroid nodules(BethesdaⅢ/Ⅳ/Ⅴ)which underwentboth fine needle aspiration biopsy and surgical treatment were enrolled,including 112 malignant nodules and 23 benign nodules.Differences of sonographic characteristics between the benign and malignant nodules were assessed.The Logistic regressionanalysis was performed to construct the prediction models of conventional ultrasound and the association of conventionalultrasound and cytological results.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value ofthe judgment of malignant thyroid nodules with IC by conventional ultrasound,conventional ultrasound+cytological results,conventional ultrasound+elastography and conventional ultrasound+cytological results+elastography were calculated.The ROCcurves were plotted correspondingly,and the area under the curve were calculated and compared.ResultsThere were significantdifferences in composition,taller-than-wide shape,margin,blood flow distribution,and elasticity score between the benign andmalignant nodules(all P<0.05).The area under ROC curve for conventional ultrasound,conventional ultrasound+cytologicalresult,conventional ultrasound+elastography and conventional ultrasound+cytological results+elastography were 0.760,0.784,0.643 and 0.660,respectively.Conventional ultrasound+cytological results showed the best diagnostic efficacy for malignant nodules,with sensitivity,specificity,accuracy,positive predictive value and negative predictive value of 74.11%,82.61%,75.56%,95.40%and 39.58%,respectively.Conventional ultrasound+elastography scores showed the highest sensitivity indiagnosis of malignant nodules(98.21%),and conventional ultrasound+cytological results showed the highest specificity(82.61%).ConclusionConventional ultrasound and strain elastography are valuable in the differential diagnosis of noduleswith IC.The sensitivity of conventional ultrasound combined with elastography in the diagnosis of malignant nodules is increased,but the specificity is decreased and the diagnostic efficiency is not improved.