TIRADS联合剪切波弹性成像对BSRTCⅢ类结节的诊断价值

Combined Analysis of TIRADS and Shear Wave Elastography for the Diagnosis of Bethesda Category Ⅲ Nodules

目的探讨甲状腺影像报告和数据系统(TIRADS)联合剪切波弹性成像(SWE)对甲状腺细胞病理学Bethesda报告系统(BSRTC)Ⅲ类结节的诊断价值。资料与方法选取2016年1月至2019年12月在南京医科大学第一附属医院行超声引导下甲状腺细针穿刺的127例患者,共127个BSRTCⅢ类结节。所有结节同时行TIRADS分类和SWE检查。以组织学病理结果为“金标准”,比较TIRADS、SWE及两者联合对BSRTCⅢ类甲状腺结节的诊断价值。结果组织学病理结果显示:恶性结节49个;良性结节78个。TIRADS分类鉴别诊断BSRTCⅢ类结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确度分别为75.5%、87.2%、78.7%、85.0%、82.7%。SWE鉴别诊断BSRTCⅢ类结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确度分别为73.5%、82.1%、72.0%、83.1%、78.7%。TIRADS分类和SWE联合诊断BSRTCⅢ类结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确度分别为93.9%、82.1%、76.7%、95.5%、86.6%。联合诊断较TIRADS、SWE单独诊断具有较高的敏感度(P=0.004,P=0.002)和阴性预测值(χ^(2)=4.406,P=0.036;χ^(2)=5.582,P=0.018)。结论TIRADS和SWE联合诊断明显提高了对BSRTCⅢ类结节的诊断敏感度和阴性预测值,具有良好的诊断效能。

Purpose To determine the diagnostic value of thyroid imaging reporting and data system(TIRADS)combined with shear wave elastography(SWE)in Bethesda system categoryⅢnodules.Materials and Methods A total of 127 nodules from 127 patients who underwent ultrasound-guided fine needle aspiration(FNA)were retrospectively selected.Each nodule underwent with TIRADS classification and SWE was confirmed by histopathology.Chi-square test was used to access the diagnostic efficacy of TIRADS,SWE and the combination of two methods based on the histopathology findings regarded as the“golden standard”.Results According to histopathology findings,49 nodules were malignant and 78 nodules were benign.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and accuracy of TIRADS were 75.5%,87.2%,78.7%,85.0% and 82.7%,respectively.The sensitivity,specificity,PPV,NPV and accuracy of SWE were 73.5%,82.1%,72.0%,83.1%and 78.7%,respectively.The sensitivity,specificity,PPV,NPV and accuracy of the combination of two methods were 93.9%,82.1%,76.7%,95.5% and 86.6%,respectively.The combination of two methods significantly increased sensitivity(P=0.004,P=0.002)and NPV(χ^(2)=4.406,P=0.036;χ^(2)=5.582,P=0.018)when compared with TIRADS and SWE.Conclusion The combination of TIRADS and SWE can improve the sensitivity and NPV,suggesting the great value in differentiating Bethesda system categoryⅢnodules.