两所不同等级医院甲状腺结节诊疗现状的比较

A comparison of diagnosis and treatment status of thyroid nodules in two hospitals with different classes

目的回顾性比较两所不同等级医院对良、恶性甲状腺结节的诊疗方式。方法收集南京中医药大学附属中西医结合医院(三甲医院,甲组,408例)和江苏省建湖县人民医院(三乙医院,乙组,155例)甲状腺结节患者术前诊断检查资料、手术方式及术后病理结果,采用美国放射学会甲状腺成像报告和数据系统(ACR-TIRADS)对所有结节进行分级,并计算总体ACR-TIRADS的诊断效能。结果与甲组相比,乙组甲状腺癌患者年龄和结节直径较大(P<0.01)。甲组甲状腺癌患者的术前颈部CT检查和超声引导下细针穿刺细胞学检查实施率高于乙组(95.99%vs.0和82.22%vs.5.56%)(P<0.01)。甲组对甲状腺良性结节处理和对甲状腺癌手术方式选择的合理率均高于乙组(88.51%vs.41.71%和94.13%vs.58.62%)(P<0.01)。ACR-TIRADS 4级诊断总体甲状腺癌的灵敏度、特异度、阳性预测值、阴性预测值和准确性分别为97.05%、68.78%、79.70%、94.86%和84.56%。结论不同等级医院在甲状腺结节术前诊断和手术治疗方式上存在显著差异,应推动基层医院甲状腺结节规范化诊疗,提高甲状腺结节的管理水平。

Objective To compare retrospectively the approaches in the diagnosis and treatment of thyroid nodules between two hospitals with different classes.Methods The data of preoperative examination,surgical methods and postoperative pathology were collected from 408 patients in the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine(grade 3 A hospital,group A)and 155 patients in Jianhu People’s Hospital of Jiangsu Province(grade 3 B hospital,group B).All the nodules were categorized by Thyroid Imaging Report and Data System proposed by the American College of Radiology(ACR-TIRADS).The ROC curve was constructed to calculate the diagnostic efficacy of ACR-TIRADS.Results Compared with group A,the age and nodal diameter of the patients with thyroid cancer were greater in group B(P<0.01).The implementation rates of preoperative neck CT examination and ultrasound-guided fine needle aspiration cytology in the patients with thyroid cancer in group A were higher than those in group B(95.99%vs.0 and 82.22%vs.5.56%)(P<0.01).The reasonableness rates in treating the benign and malignant thyroid nodules in group A were higher than those in group B(88.51%vs.41.71%and 94.13%vs.58.62%)(P<0.01).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ACR-TIRADS at grade 4 in the diagnosis of thyroid cancer were 97.05%,68.78%,79.70%,94.86%and 84.56%,respectively.Conclusion There are significant differences in the preoperative diagnosis and surgical method of thyroid nodules between the two classes hospitals.It is necessary to promote the standardized diagnosis and treatment of thyroid nodules in the primary hospitals and improve the management level of thyroid nodules.