剪切波弹性成像测量Emax联合细针细胞学检查对TI-RADS4类甲状腺结节的诊断价值

The diagnostic value of Emax detected by using shear wave elastography combined with fine needle cytology for TIRADS type 4 thyroid nodules

目的探讨剪切波弹性成像(SWE)测量最大杨氏模量值(Emax)联合细针细胞学检查(FNA)在甲状腺影像学检查报告及数据系统TI-RADS4类结节诊断中的价值。方法对2017年12月至2019年6月该院收治的常规超声检查发现的TI-RADS4类甲状腺结节103枚(96例)术前进行SWE测量Emax,选择病灶最高硬度范围行FNA检查。以术后病理学结果为“金标准”,比较SWE及其联合FNA诊断甲状腺结节的效能。结果103枚结节中术后病理结果显示良性结节62枚,恶性结节41枚;SWE最佳截点值为Emax>44.5 kPa,其诊断甲状腺结节灵敏度为70.73%,特异性为74.19%,准确率为72.82%;SWE联合FNA诊断甲状腺结节的灵敏度为85.37%,特异性为100%,准确率为94.17%;2种检查方法结合可提高TI-RADS4类甲状腺结节诊断的灵敏度、特异性和准确率,差异均有统计学意义(P<0.05)。结论SWE测量Emax联合FNA检查有助于进一步提高诊断TI-RADS4类甲状腺结节的灵敏度、特异性及准确率,临床诊断价值较高,可为术前诊断提供确切的依据。

Objective To investigate the value of Emax combined with fine needle cytology(FNA)in the diagnosis of thyroid nodules in the imaging report and data system TI-RADS4.Methods 103 TI-RADS4 thyroid nodules(96 cases)were found by routine ultrasonography.Emax was measured by SWE before operation,and FNA was performed at the highest hardness range.The diagnostic efficacy of SWE and its combination with FNA in thyroid nodules was compared according to the pathological results after operation.Results Among 103 nodules,there were 62 benign nodules,41 malignant nodules and the best cut-off point of SWE was Emax>44.5KPa.The sensitivity,specificity and accuracy of SWE combined with FNA in the diagnosis of thyroid nodules were 70.73%,74.19%and 72.82%,respectively.The sensitivity,specificity and accuracy of SWE combined with FNA in the diagnosis of thyroid nodules were 85.37%,100%and 94.17%,respectively.The sensitivity,specificity and accuracy of diagnosis of TI-RADS 4 thyroid nodules can be improved by the combination of methods,and the difference is statistically significant(P<0.05).Conclusion Shear wave elastography Emax combined with FNA examination is helpful to further improve the sensitivity,specificity and accuracy of diagnosis of TI-RADS type 4 thyroid nodules.It has high clinical diagnostic value and can provide accurate basis for preoperative diagnosis.