细针穿刺活检联合超声实时弹性成像对甲状腺结节的诊断价值

Clinical value of fine needle aspiration biopsy combined with real-time elastic imaging in the diagnosis of thyroid nodules

目的探讨细针穿刺活检联合超声实时弹性成像对甲状腺结节的诊断价值。方法选取鹤山市人民医院2018年5月至2019年11月收治、同时接受细针穿刺活检、超声实时弹性成像检查的甲状腺结节患者40例(58枚结节),与手术病理结果进行对照分析,对于细针穿刺活检、实时弹性成像以及二者联合的诊断价值进行评价和影响因素分析。结果经手术病理证实,40例(58枚)甲状腺结节中,良性结节、恶性结节分别为41枚(41/58,70.7%)、17枚(17/58,29.3%)。细针穿刺活检、实时弹性成像联合外检测时,灵敏度、特异度、阳性预测值、阴性预测值、ROC曲线下面积分别为88.7%、86.5%、88.4%、85.4%、0.843,高于其单项指标,差异有统计学意义(χ^2=6.131、5.164、5.142、7.196、7.668,均P<0.05);细针穿刺活检联合超声实时弹性成像诊断甲状腺结节无合并钙化或桥本甲状腺炎的灵敏度(84.3%、90.2%)、特异度(83.4%、97.9%)明显高于甲状腺结节合并钙化或桥本甲状腺炎的灵敏度(80.2%,84.2%)、特异度(75.2%、96.5%),差异均有统计学意义(χ^2=3.154、2.166,均P<0.05)。结论细针穿刺活检联合超声实时弹性成像,相比于单独检测指标,诊断甲状腺结节的灵敏度、特异度明显增高;甲状腺结节是/否合并钙化或桥本甲状腺炎是影响诊断的重要因素。

Objective To analyze the clinical value of fine needle aspiration biopsy combined with real-time elastography in the diagnosis of thyroid nodules.Methods From May 2018 to November 2019,40 patients(58 nodules)with thyroid nodules who underwent fine needle aspiration biopsy and real-time elastography in Heshan People's Hospital were randomly selected,and the results were compared with surgical pathology.Fine needle aspiration biopsy,real-time elastography,and the combined diagnostic value of both were evaluated and the influencing factors were analyzed.Results Among the 40 cases(58 nodules)of thyroid nodules,41 nodules(41/58,70.689%)and 17 nodules(17/58,29.311%)were benign and malignant.The sensitivity,specificity,positive predictive value,negative predictive value,the area under the ROC curve of fine needle biopsy,real-time elastography outside the joint detection were 88.645%,86.496%,88.424%,85.453%and 0.843,respectively,which were higher than the single index,the differences were statistically significant(χ^2=6.131,5.164,5.1427.196,7.668,all P<0.05).The sensitivity(84.3%,90.2%),specificity(83.4%,97.9%)of fine needle biopsy combined with real-time ultrasound elastography in the diagnosis of thyroid nodules without merge calcification or Hashimoto's thyroiditis were significantly higher than those in the diagnosis of merged thyroid nodule calcification or Hashimoto's thyroiditis[sensitivity(80.2%,84.2%),specificity(75.2%,96.5%)],the differences were statistically significant(χ^2=3.154,2.166,all P<0.05).Conclusion Compared with the individual detection indicators,fine needle aspiration biopsy combined with real-time elastography has higher sensitivity and specificity in the diagnosis of thyroid nodules,and thyroid nodules with/without calcification or Hashimoto's thyroiditis is an important factor affecting diagnosis.