超微血管成像、超声弹性成像及细针穿刺活检对TI-RADS 4类甲状腺结节诊断的应用价值

Application value of superb microvascular imaging,ultrasound elastography and fine needle aspiration biopsy in the diagnosis of TI-RADS 4 thyroid nodules

目的:探讨超微血管成像(superb microvascular imaging,SMI)、超声弹性成像及超声引导下的细针穿刺活检(fine needle aspiration biopsy,FNAB)对甲状腺影像报告与数据系统(thyroid imaging reporting and data system,TI-RADS)4类甲状腺结节诊断的应用价值。方法:选择54例病人共61个TI-RADS 4类结节作为研究对象,在手术前行SMI、超声弹性成像及FNAB检查,以手术后的病理学结果作为“金标准”,分析比较SMI、超声弹性成像,FNAB及三者联合对诊断TI-RADS 4类甲状腺结节的应用价值。结果:61个结节,病理学证实良性24个,恶性37个。SMI诊断甲状腺结节的灵敏度、特异度和准确率分别为62.52%、64.86%和63.93%;超声弹性成像分别为70.83%、72.97%和72.13%;FNAB分别为83.33%、83.78%和83.61%;三者联合诊断分别为91.67%、91.89%和91.80%。三种方法联合诊断TI-RADS 4类甲状腺结节的特异度和准确率均高于SMI、超声弹性成像及FNAB单独诊断(P<0.05和P<0.01),但联合诊断的灵敏度与SMI、超声弹性成像及FNAB单独诊断差异无统计学意义(P>0.05)。结论:单独运用SMI、超声弹性成像及FNAB在诊断TI-RADS 4类甲状腺结节良恶性时均存在一定不足,三者联合使用可明显提高诊断TI-RADS 4类甲状腺结节性质的特异度及准确率,具有较高的临床价值。

Objective:To investigate the application value of superb microvascular imaging(SMI),ultrasonic elastography and ultrasound-guided fine needle aspiration biopsy(FNAB)in the diagnosis of thyroid imaging reporting and data system(TI-RADS)4 thyroid nodules.Methods:Sixty-one TI-RADS 4 nodules in 54 patients were detected using SMI,ultrasonic elastography and FNAB before surgery.The results of postoperative pathology was set as the"gold standard",the application value of SMI,ultrasonic elastography,FNAB and combination of the three in the diagnosis of TI-RADS 4 thyroid nodules were analyzed and compared.Results:Among the 61 nodules,the results of pathology showed that 24 cases were benign,and 37 cases were malignant.In the diagnosis of thyroid nodules,the sensitivity,specificity and accuracy of SMI were 62.52%,64.86%and 63.93%,respectively;the sensitivity,specificity and accuracy of ultrasonic elastography were 70.83%,72.97%and 72.13%,respectively;the sensitivity,specificity and accuracy of FNAB were 83.33%,83.78%and 83.61%,respectively;and the sensitivity,specificity and accuracy of combination of the three were 91.67%,91.89%and 91.80%,respectively.The specificity and accuracy of combination of the three in the diagnosis of TI-RADS 4 nodules were higher than those of SMI,ultrasonic elastography and FNAB alone(P<0.05 and P<0.01).The differences of the sensitivity between combined diagnosis,and SMI,ultrasound elastography and FNAB alone in the diagnosis of TI-RADS 4 thyroid nodules were not statistically significant(P>0.05).Conclusions:Single application of SMI,ultrasound elastography and FNAB in the diagnosis or benign or malignant TI-RADS 4 thyroid nodule has certain deficiencies.Combined use of the three can significantly improve the specificity and accuracy of the diagnosis of the nature of TI-RADS 4 thyroid nodules,which has high clinical value.