超声TI-RADS分级联合三维剪切波弹性成像对甲状腺微小癌的诊断效能

Diagnostic efficiency of ultrasound TI-RADS combined with three-dimensional shear wave elastography in thyroid microcarcinoma

目的·评估超声甲状腺影像报告与数据系统(thyroid imaging-reporting and data system,TI-RADS)联合三维剪切波弹性成像(three-dimensional shear wave elastography,3D-SWE)技术对甲状腺微小癌的诊断价值。方法·回顾性分析2017年6月—2018年1月于上海交通大学医学院附属仁济医院超声医学科行超声检查的甲状腺结节患者66例(共67个结节,结节最大直径5.0~10.0 mm,为常规TI-RADS 4~5级)。所有甲状腺结节经常规超声检查后,均采用TI-RADS分级进行评估,并行3D-SWE技术检查、细针穿刺活检及BRAFV600E基因检测。所有结节依据手术病理或细针穿刺细胞学联合BRAFV600E基因突变检测结果分为良性组及恶性组,计算由3D-SWE区分的甲状腺良、恶性结节的阈值,并应用病灶杨氏模量参数进一步调整分级成为联合TI-RADS分级(即经常规超声联合3D-SWE技术调整后的联合TI-RADS分级),用于结节的良、恶性检测。结果·67个甲状腺结节中,恶性组38个,良性组29个。以三维矢状面最大杨氏模量(three-dimensional maximum Young's modulus in sagittal plane,3D-S-Emax)为诊断指标,鉴别甲状腺结节良恶性的阈值、曲线下面积(area under the curve,AUC)、灵敏度、特异度和准确度分别为24.6 kPa、0.683、65.8%、65.5%和65.7%。采用常规TI-RADS分级和联合TI-RADS分级分别对甲状腺结节行良恶性鉴别诊断发现,AUC分别为0.794和0.801且差异无统计学意义;而敏感度、特异度和准确度分别为63.2%、82.8%、71.6%以及86.8%、69.0%、79.1%,仅敏感度间差异具有统计学意义(P=0.004)。结论·常规超声联合3D-SWE技术调整的联合TI-RADS分级与常规TI-RADS分级虽然对甲状腺微小癌具有相似的诊断价值,但前者具有较高的诊断敏感度及较低的漏诊率。

Objective·To evaluate the diagnostic value of ultrasound thyroid imaging-reporting and data system(TI-RADS)combined with threedimensional shear wave elastography(3D-SWE)technique in thyroid microcarcinoma.Methods·From Jun.2017 to Jan.2018,66 patients with 67 thyroid nodules in the Department of Ultrasound of Renji Hospital,Shanghai Jiao Tong University School of Medicine were recruited.All thyroid nodules were classified as TI-RADS 4-5,and the maximum diameter was 5.0-10.0 mm.After routine ultrasound examination,all thyroid nodules were evaluated by TI-RADS classification,3D-SWE technique,fine-needle aspiration biopsy(FNAB)examination and an additional BRAFV600E gene mutation test.All the nodules were divided into benign group and malignant group according to the results of surgical pathology or fine-needle aspiration combined with BRAFV600E gene detection.The threshold value of the parameters in 3D-SWE for differentiating benign and malignant thyroid nodules was calculated,and the TI-RADS was further adjusted by Young's modulus parameters of the lesion to obtain combined TI-RADS(conventional ultrasound combined with 3D-SWE)for detecting the benign and malignant nodules.Results·Among the 67 thyroid nodules,38 of them were malignant and 29 were benign.The optimal cut-off point of three-dimensional maximum Young's modulus in sagittal plane(3D-S-Emax)was 24.6 kPa.The area under the curve(AUC)value,sensitivity,specificity and accuracy of 3D-S-Emax were 0.683,65.8%,65.5%and 65.7%,respectively.The AUC value for combined TI-RADS was 0.801 and that for conventional TI-RADS was 0.794,without statistical difference.The sensitivity,specificity and accuracy of conventional TI-RADS and combined TI-RADS were 63.2%,82.8%,71.6%,and 86.8%,69.0%,79.1%,respectively.Only sensitivity of combined TI-RADS was significantly higher than that of conventional TI-RADS(P=0.004).Conclusion·Combined TI-RADS and conventional TI-RADS have similar diagnostic value in thyroid microcarcinoma,while combined TI-RADS has higher diagnostic sensitivity and lower missed diagnosis rate.