TI-RADS分类联合细针穿刺活检术对甲状腺结节的诊断价值

TI-RADS classification combined with fine needle aspiration biopsy in the diagnosis of thyroid nodules

目的评估甲状腺影像报告数据系统(TI-RADS)分类联合细针穿刺活检术(fine needle aspiration biopsy,FNAB)对甲状腺结节诊断的应用价值。方法对经手术病理结果验证的124个甲状腺结节的超声特征和FNAB穿刺细胞学结果进行回顾性分析,分别对两种检测方法及联合检测判定甲状腺结节良恶性的准确率进行分析。结果124个甲状腺结节中,组织病理学证实87个恶性结节,37个良性结节。TI-RADS、FNAB与二者联合诊断甲状腺结节良、恶性ROC曲线下面积分别为0.767、0.855和0.818。FNAB诊断方法对应的ROC曲线下面积高于TI-RADS检测和二者联合诊断,差异均有统计学意义(P<0.05)。约登指数分别为0.427和0.715时,TI-RADS检测和Bethesda报告系统最佳界值分别为≥4B和≥Ⅴ。此时TI-RADS、FNAB与二者联合诊断甲状腺结节敏感度分别为64.3%、85.0%、91.9%;特异度分别为78.3%、86.4%、64.8%;准确率分别为68.5%、85.4%、83.8%;阳性预测值分别为87.5%、93.6%、96.3%;阴性预测值分别为48.3%、71.1%、77.4%。三者敏感度、准确率、阴性预测值差异有统计学意义(P<0.05)。TI-RADS 4A类结节联合FNAB的诊断准确率优于单独采用TI-RADS分类方法,差异有统计学意义(P<0.05)。TI-RADS 3、4B、4C类结节联合FNAB检测,与两者单独检测方法比较,诊断准确率差异无统计学意义(P>0.05)。结论TI-RADS联合FNAB能显著提高TI-RADS 4A类甲状腺结节诊断准确率,FNAB联合TI-RADS能有效降低FNAB穿刺假阴性率,从而进一步提高甲状腺结节诊断准确率。

Objective To assess the application value of TI-RADS classification combined with fine needle aspiration biopsy(FNAB)in diagnosis of thyroid nodules.Methods The ultrasonic features and FNAB cytological results of 124 thyroid nodules confirmed by pathology were analyzed retrospectively,and the diagnostic efficacy of single and combined methods were compared.Results Among 124 thyroid nodules,87 were malignant and 37 were benign.The area under ROC curve(AUC)of TI-RADS,FNAB and their combination in the differentiation between benign and malignant thyroid nodules was 0.767,0.855 and 0.818,respectively.The AUC of FNAB was higher than that of TI-RADS and the combination of the two methods(P<0.05).The Youden index were 0.427 and 0.715,while the best cut-off values of TI-RADS detection and Bethesda reporting system were≥4B and≥V,respectively.The sensitivity of TI-RADS,FNAB and their combination in the diagnosis of malignant thyroid nodules was 64.3%,85.0%and 91.9%,respectively.The specificity was 78.3%,86.4%and 64.8%,respectively.The accuracy was 68.5%,85.4%and 83.8%,respectively.The positive predictive values were 87.5%,93.6%and 96.3%,respectively.The negative predictive values were 48.3%,71.1%and 77.4%,respectively.There were significant differences in sensitivity,accuracy and negative predictive value among the three groups(P<0.05).The diagnostic accuracy of TI-RADS 4A nodules combined with FNAB was better than that of TI-RADS alone(P<0.05);there was no significant difference in diagnostic accuracy between TI-RADS 3,4b,4C nodules combined with FNAB and the two methods alone(P>0.05).Conclusion TI-RADS combined with FNAB can significantly improve the diagnostic accuracy of TI-RADS 4A thyroid nodules,FNAB combined with TI-RADS classification can reduce the ratio of false negative nodules performed by FNAB,so as to improve the diagnostic accuracy of thyroid nodules.