超声引导下细针穿刺细胞病理学联合CK19、TPO检测对TI-RADS 4a和4b类甲状腺结节的诊断价值

Diagnostic value of ultrasound-guided fine-needle aspiration cytology combined with CK19 and TPO detection in TI-RADS 4a and 4b thyroid nodules

目的 评价超声引导下细针穿刺(US-FNA)细胞病理学联合和细胞角蛋白19(CK19)、甲状腺过氧化物酶抗体(TPO)检测对甲状腺影像报告和数据系统(TI-RADS)4a和4b类甲状腺结节良恶性的诊断价值。方法 收集2020年3月至2021年9月就诊于安徽医科大学第四附属医院经手术病理证实的TI-RADS 4a和4b类甲状腺结节,共计148个结节符合纳入标准。以手术病理结果为金标准,计算并对比US-FNA、CK19、TPO及三者联合对TI-RADS4a和4b类甲状腺结节良恶性的诊断效能。结果研究发现US-FNA联合CK19、TPO检测诊断TI-RADS 4a和4b类甲状腺结节良恶性的敏感度、特异度、准确率、阳性预测值和阴性预测值分别为95.45%(42/44)、93.27%(97/104)、93.93%(139/148)、85.71%(42/49)和97.98%(97/99),指标均高于单独运用三者的诊断效能。US-FNA、CK19、TPO和三者联合的曲线下面积分别为0.839、0.882、0.860和0.944,差异有统计学意义(P<0.01)。结论 US-FNA联合CK19、TPO检测有助于提高甲状腺TI-RADS4a和4b类结节良恶性鉴别的灵敏度、特异度和准确度。

Objective To evaluate the diagnostic value of ultrasound-guided fine-needle aspiration (US-FNA) cytopathology combined with cytokeratin 19 (CK19) and thyroid peroxidase antibody (TPO) detection in the diagnosis of Thyroid Imaging Reporting and Data System (TI-RADS) 4a and 4b thyroid nodules.Methods TI-RADS 4a and 4b thyroid nodules confirmed by surgery and pathology in The Fourth Affiliated Hospital of Anhui Medical University from March 2020 to September 2021 were enrolled in the present study.And there are 148 nodules that met the inclusion criteria.Then taking the postoperation pathological results as the gold standard,the diagnostic efficacy of US-FNA,CK19,TPO and the combination of them on TI-RADS4a and 4b thyroid nodules were calculated and compared.Results The study found that the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of US-FNA combined with CK19 and TPO in the diagnosis of TI-RADS 4a and 4b thyroid nodules were 95.45%(42/44),93.27%(97/104),93.93%(139/148),85.71%(42/49) and 97.98%(97/99),respectively.And these indicators were higher than those of US-FNA,CK19,TPO alone.The area under the curve of US-FNA,CK19,TPO and the combination of them were 0.839,0.882,0.860 and 0.944,respectively,and the difference was statistically significant (P<0.01).Conclusion The combination of US-FNA with CK19 and TPO detectionis can help to improve the sensitivity,specificity and accuracy of thyroid TI-RADS 4a and 4b nodules in the differentiation of benign and malignant.