微小钙化及纵横比大于1在TI-RADS 4类甲状腺结节中的诊断价值

Diagnostic value of microcalcification and longitudinal-transverse plane ratios>1 in predicting thyroid nodules of TI-RADS category 4

目的:探讨超声影像为微小钙化及纵横比>1在TI-RADS 4类(Kwak版)甲状腺恶性结节中的诊断价值。方法:回顾性分析湖北省中西医结合医院普通外科2018年1月—2020年6月诊治的118例甲状腺彩超检查为TI-RADS 4类甲状腺结节患者,共169枚结节,所有甲状腺结节经彩超检查后,采用Kwak版TI-RADS进行恶性风险分类评估。良恶性结节的诊断金标准为手术后常规病理学检查或术前细针穿刺细胞学检查结果。单因素及多因素分析与甲状腺恶性结节相关的影像征象,探讨微小钙化及纵横比>1在TI-RADS 4类甲状腺结良恶性节中的诊断价值,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),分析其诊断的敏感度、特异度及诊断效能。结果:118例169枚甲状腺TI-RADS 4类结节,恶性结节有40.8%。单因素分析显示,甲状腺恶性结节与结节呈实性(P=0.001)、长径≤1 cm(P=0.009)、低回声或极低回声(P=0.001)、有微小钙化(P=0.001)、纵横比>1(P=0.001),边界不清(P=0.001)、有微分叶或形态不规则或周边有毛刺征(P=0.001)相关,其中微小钙化、纵横比>1、有微分叶或形态不规则或周边有毛刺征是甲状腺结节为恶性的独立危险因素(P<0.05)。诊断甲状腺恶性结节,微小钙化的敏感度为60.9%,特异度为83.0%,AUC为0.719;纵横比>1的敏感度为56.5%,特异度为90.0%,AUC为0.733;微小钙化或纵横比>1的敏感度为79.8%,特异度为76.0%,AUC为0.779;微小钙化且纵横比>1的敏感度为37.6%,特异度为97.0%,AUC为0.673。结论:甲状腺恶性结节超声征象多表现为低回声或极低回声、微小钙化、纵横比>1、有微分叶或形态不规则或周边有毛刺征,微小钙化或纵横比>1诊断TI-RADS 4类甲状腺恶性结节的诊断效能最高,可作为超声检查筛查甲状腺癌的有价值的指标。

Objective:The purpose of this study was to investigate the diagnostic value of ultrasound imaging for microcalcification and longitudinal-transverse plane ratios>1 in predicting malignant thyroid nodules of TI-RADS category 4(Kwak version).Methods:The retrospective analysis was performed in 118 cases with thyroid nodules treated from January 2018 to June 2020 in Department of General Surgery,Hubei Hospital of Integrated Traditional Chinese and Western Medicine.A total of 169 thyroid nodules of TI-RADS category 4 were included.After ultrasonography examination,the malignant risk of thyroid nodules was assessed according to TI-RADS(Kwak version).The gold standards for the diagnosis of benign or malignant nodules were based on the result of postoperative histopathological examination or preoperative fine needle aspiration cytology.Univariate and multivariate analysis were conducted to discuss imaging features related to malignant thyroid nodules and the diagnostic value of microcalcification and longitudinal-transverse plane ratios>1 were analyzed to predict malignant thyroid nodules of TI-RADS category 4.ROC curve was drawn and area under curve(AUC)was calculated to evaluate the diagnostic sensitivity,specificity and efficacy of microcalcification and longitudinal-transverse plane ratios>1.Results:Among 118 cases,169 thyroid nodules of TI-RADS 4 category,malignant nodules took up 40.8%.Univariate analysis showed that solid nodules(P=0.001),less than 1 cm in diameter(P=0.009),low echo or extremely low echo(P=0.001),microcalcification(P=0.001),longitudinal-transverse plane ratios>1(P=0.001),differential lobe or the irregular morphology or the burr on boundary(P=0.001)and the obscure boundary(P=0.001)were related to malignant nodules.Even more,microcalcification,longitudinal-transverse plane ratios>1,differential lobe or the irregular morphology or the burr on boundary were independent risk factors associated with malignancy.For diagnosing malignant thyroid nodules,the sensitivity,specificity and AUC of microcalcification were 60.9%,83.0%and 0.719 respectively.The diagnostic sensitivity,specificity and AUC under the ROC curve of longitudinal-transverse plane ratios>1 was 56.5%,90.0%and 0.733.The sensitivity,specificity and AUC of microcalcification or longitudinal-transverse plane ratios>1 were 79.8%,76.0%and 0.779 respectively.The diagnostic sensitivity,specificity and AUC of microcalcification and longitudinal-transverse plane ratios>1 was 37.6%,97.0%and 0.673.Conclusion:The ultrasonography of malignant thyroid nodule were likely to display microcalcification,longitudinal-transverse plane ratios>1,differential lobe or the irregular morphology or the burr on boundary.Compared with single ultrasonic sign,microcalcification or longitudinal and transverse plane ratios>1 has the highest diagnostic efficiency in predicting malignant thyroid nodules of TI-RADS category 4,which can be regarded as one valuable ultrasonography indicator for predicting thyroid cancer.