超声TI-RADS分类与细针穿刺活检在诊断甲状腺恶性结节中的临床应用

The clinical application of ultrasound TI-RADS classification and fine needle aspiration biopsy in the diagnosis of malignant thyroid nodules

目的探讨甲状腺影像报告和数据系统分类(TI-RADS)与细针穿刺活检(FNA)在诊断甲状腺恶性结节中的临床应用价值。方法回顾性分析我院于2020年1月至2020年12月期间常规甲状腺超声检查中TI-RADS分类≥3类的585例患者的588个甲状腺结节,所有患者均接受甲状腺细针穿刺细胞学活检,其中266个甲状腺结节手术切除,以大体病理为金标准,评价超声TI-RADS分类与细针穿刺活检诊断甲状腺恶性结节的效能。结果588个甲状腺结节细胞学病理诊断恶性243例、良性193例、性质不确定152例,超声TI-RADS 3、4、5类甲状腺恶性结节的阳性率分别为3.01%(4/133)、38.87%(110/283)、75.00%(129/172);266个结节手术切除,大体病理诊断恶性211例、良性55例,细针穿刺活检诊断甲状腺恶性结节的敏感性、特异性、准确性分别为98.46%、93.02%、97.48%,阳性预测值为98.46%,阴性预测值为93.02%,阳性似然比为14.11,阴性似然比为0.017;穿刺感硬及有砂粒感诊断为甲状腺恶性结节的准确性明显高于穿刺感软及无砂粒感,差异有统计学意义(χ^(2)=70.206,65.083;P=0.000,0.000);超声TI-RADS分类及细针穿刺活检诊断甲状腺恶性结节的ROC曲线下面积分别为0.881及0.954。结论超声TI-RADS分类结合细针穿刺活检对甲状腺恶性结节有较高的诊断价值,可更准确、更安全地判断甲状腺结节的良恶性,值得临床推广。

Objective To explore the clinical application value of ultrasound TI-RADS classification and fine needle aspiration biopsy in the diagnosis of malignant thyroid nodules.Methods A retrospective analysis of 588 thyroid nodules in 585 patients with TI-RADS classification≥3 in routine thyroid ultrasound examinations in our hospital from January 2020 to December 2020.All patients underwent thyroid fine-needle aspiration cytology biopsy.Among them,266 thyroid nodules were surgically removed.Using gross pathology as the gold standard,to evaluate the efficacy of ultrasound TI-RADS classification and fine-needle aspiration biopsy in diagnosing malignant thyroid nodules.Results Among 588 thyroid nodules in 585 patients,243 cases were malignant,193 cases were benign,and 152 cases were uncertain.The positive rates of ultrasound TI-RADS 3,4,and 5 thyroid malignant nodules were 3.01%(4/133),38.87%(110/283),75.00%(129/172),respectively.266 nodules were surgically removed,gross pathological results were available 211 malignant and 55 benign.The sensitivity,specificity,and accuracy of fine-needle aspiration biopsy in the diagnosis of malignant thyroid nodules were 98.46%,93.02%,and 97.48%,respectively.The positive predictive value was 98.46%,the negative predictive value was 93.02%,the positive likelihood ratio was 14.11 and the negative likelihood ratio was 0.017.The accuracy of diagnosing thyroid malignant nodules with hard puncture feeling and grit sensation was significantly higher than that with soft puncture feeling and no grit sensation,and the difference was statistically significant(χ^(2)=70.206,65.083;P=0.000,0.000).The areas under the ROC curve of ultrasonic TI-RADS classification and fine-needle aspiration biopsy for the diagnosis of malignant thyroid nodules were 0.881 and 0.954,respectively.Conclusions Ultrasound TI-RADS classification combined with fine-needle aspiration biopsy has higher diagnostic value for malignant thyroid nodules,which can distinguish benign and malignant thyroid nodules more accurately and safely,and is worthy of clinical promotion.