超声弹性成像联合细针穿刺细胞学检查诊断桥本氏甲状腺炎背景下结节良恶性的价值

Ultrasonic elastography combined with fine needle aspiration cytology in the diagnosis of benign and malignant nodules with Hashimoto’s thyroiditis

目的探讨超声弹性成像(UE)联合细针穿刺细胞学检查(FNAC)鉴别诊断桥本氏甲状腺炎(HT)背景下结节良恶性的价值。方法选取我院经手术病理证实的124例HT背景下甲状腺结节患者,其中良性结节66例(良性组),恶性结节58例(恶性组)。两组均行UE和FNAC检查,获得UE评分、应变率比值及FNAC分类情况,结果进行比较分析。以病理结果为金标准,分析不同方法单独及联合应用对HT背景下甲状腺结节良恶性的诊断价值。结果良性组UE评分0~2分者49例,3~4分者17例;恶性组UE评分0~2分者13例,3~4分者45例;两组比较差异有统计学意义(P<0.05)。良、恶性组应变率比值分别为2.42±0.88和3.68±1.22,差异有统计学意义(t=6.638,P=0.000)。FNAC检查显示,良性组Ⅱ类结节占比高于恶性组(81.82%vs.1.72%),恶性组Ⅵ类结节占比高于良性组(75.86%vs.1.52%),差异有统计学意义(Z=4.595,P<0.05)。FNAC、FNAC+UE评分、FNAC+应变率比值、FNAC+UE评分+应变率比值的诊断敏感性、阴性预测值均高于UE评分、应变率比值(均P<0.05),应变率比值的特异性高于UE评分、FNAC+应变率比值、FNAC+UE评分+应变率比值(均P<0.05),FNAC、FNAC+应变率比值的诊断准确率均高于UE评分(均P<0.05)。结论 UE联合FNAC鉴别诊断HT背景下甲状腺结节良恶性具有较高价值。

Objective cytology(FNAC)in the differential diagnosis of benign and malignant thyroid nodules with Hashimoto’s thyroiditis(HT).Methods including 66 benign nodules(benign group)and 58 malignant nodules(malignant group).Both groups were examined by UE and FNAC,the UE score,strain rate ratio and FNAC classification were obtained.The results were compared and analyzed.Taking the pathological results as the gold standard,the value of different methods application alone and combined in the diagnosis of benign and malignant thyroid nodules with HT was analyzed.ResultsIn the benign group,there were 49 patients with UE score of 0~2,17 patients with UE score of 3~4.In malignant group,there were 13 patients with UE score of 0~2,and 45 patients with UE score of 3~4.There was statistical significance in UE score between the two groups(P<0.05).The strain rate ratios of benign benign and malignant groups were 2.42±0.88 and 3.68±1.22,respectively,with statistical significance(t=6.638,P=0.000).FNAC showed that the proportion of type Ⅱ nodules in benign group was significantly higher than that of malignant group(81.82% vs.1.72%),and the proportion of type Ⅵ nodules in malignant group was significantly higher than that of benign group(75.86% vs.1.52%),there was statistical significance(Z=4.595,P<0.05).The diagnostic sensitivity and negative predictive value of FNAC,FNAC+UE score,FNAC+strain rate ratio,FNAC+UE score+strain rate ratio were higher than those of UE score and strain rate ratio(all P<0.05),the specificity of strain rate ratio was higher than that of UE score,FNAC+strain rate ratio,FNAC+UE score+strain rate ratio(all P<0.05),and the diagnostic accuracy of FNAC and FNAC+strain rate ratio were higher than that of UE score(both P<0.05).Conclusion thyroid nodules with HT.