超声实时弹性成像技术对甲状腺实性结节良恶性鉴别价值

Value of ultrasound real-time elastography in differentiating benign from malignant solid thyroid nodules

目的探讨超声实时弹性成像(RTE)技术对甲状腺实性结节良恶性的鉴别价值。方法回顾性选择2018年2月至2019年8月期间在郫都区人民医院行RTE检查的甲状腺结节患者125例。患者均在常规超声基础上行RTE检查,以超声弹性对比指数(ECI)为评价指标,以病理检查结果为金标准,以受试者操作特征(ROC)曲线分析ECI对甲状腺实性结节良恶性的鉴别价值;采用logistic回归分析判断影响ECI值的因素。结果125例甲状腺实性结节患者中良性结节74例,恶性结节51例。甲状腺良性结节的ECI值低于恶性结节(2.71±0.83比3.42±1.14,t=–4.030,P<0.001)。ROC曲线分析结果显示,ECI鉴别甲状腺实性结节良恶性的最佳阈值为3.07,其曲线下面积为0.806[95%CI(0.717,0.894),P<0.001],敏感度为80.3%,特异度为70.4%。多因素logistic回归分析显示,甲状腺结节合并弥漫性病变、有钙化及最大结节直径≥1 cm为ECI值升高的危险因素(P<0.05)。ECI对无弥漫性病变、无钙化、最大结节直径<1 cm的甲状腺实性结节良恶性鉴别的敏感度、特异度、准确度及阳性预测值均较高(均超过80%),但其对有弥漫性病变、有钙化及最大结节直径≥1 cm的甲状腺实性结节良恶性鉴别的敏感度、特异度、准确度及阳性预测值均较低(均未超过60%)。结论RTE技术获得的ECI可用于甲状腺实性结节的良恶性鉴别,甲状腺结节有无合并弥漫性病变、钙化情况及结节大小为ECI鉴别甲状腺实性结节良恶性的影响因素,临床诊断时应注意综合分析上述因素对诊断结果的影响。

Objective To explore value of ultrasound real-time elastography(RTE)technology for identification of benign and malignant solid thyroid nodules.Methods A retrospective analysis was performed on 125 patients with thyroid nodules who underwent ultrasound RTE in this hospital from February 2018 to August 2019.All patients underwent RTE on the basis of conventional ultrasound.The ultrasound elasticity contrast index(ECI)was used as the evaluation index and the pathological examination result was used as the gold standard.The receiver operating characteristic(ROC)curve analysis was used to evaluate the value of ECI in the identification of benign and malignant solid thyroid nodules.Logistic regression analysis was used to analyze the influencing factors of ECI.Results Among the 125 patients with solid thyroid nodules,51 were malignant nodules,74 were benign nodules.The ECI value of patients with benign thyroid nodules was lower than that of patients with malignant nodules(2.71±0.83 versus 3.42±1.14,t=–4.030,P<0.001).The result of ROC analysis showed that the cutoff value of ECI to distinguish benign and malignant solid thyroid nodules was 3.07,area under curve of ROC was 0.806[95%CI(0.717,0.894),P<0.001],sensitivity was 80.3%,specificity was 70.4%.The multivariate logistic regression analysis showed that the thyroid nodules with diffuse lesions,calcification,and maximum nodule diameter≥1 cm were the risk factors for elevated ECI values(P<0.05).For the solid thyroid nodules without diffuse lesions,without calcification,and maximum nodule diameter<1 cm,ECI had the higher sensitivity,specificity,accuracy,and positive predictive value for the differential diagnosis of benign and malignant thyroid nodules(all exceed 80%),but these indexes were lower(under 60%)for the differential diagnosis of solid thyroid nodules with diffuse diseases,with calcification,and maximum nodule diameter≥1 cm.Conclusions ECI obtained by ultrasound RTE can be used to differentiate solid thyroid nodules from benign ones.The presence or absence of diffuse lesions,calcification,and maximum nodule diameter are the influencing factors for ECI to differentiate solid thyroid nodules.In clinical diagnosis,it should be paid attention to the comprehensive analysis of the above factors.