VTIQ联合US-FNAB对桥本甲状腺炎合并甲状腺乳头状癌颈部中央区淋巴结性质判定的价值

The value of the virtual touch tissue image quantification technique combined with ultrasound-guided fine-needle aspiration biopsy in the differential diagnosis of lymph nodes in central cervical zone for papillary thyroid carcinoma complicated with Hashim

目的:探讨声触诊组织成像量化(virtual touch tissue image quantification,VTIQ)技术联合超声引导下细针抽吸活检(ultrasound-guided fine-needle aspiration biopsy,US-FNAB)对桥本甲状腺炎(Hashimoto’s thyroiditis,HT)合并甲状腺乳头状癌(papillary thyroid carcinoma,PTC)颈部中央区肿大淋巴结性质判定的价值。方法:回顾性分析125例经病理证实的PTC合并HT患者的174枚颈部中央区肿大淋巴结,术前均行VTIQ及US-FNAB检查。VTIQ技术通过测量横向剪切波速度(shear wave velocity,SWV)来表明淋巴结的软硬,通过绘制受试者工作特征(receiver operator characteristic,ROC)曲线求取最佳诊断界值。使用US-FNAB细胞学结果判断淋巴结性质,将VTIQ、US-FNAB及VTIQ联合US-FNAB结果与术后病理对照,比较各自的诊断效果。结果:174枚颈部中央区淋巴结中,PTC转移淋巴结92枚,反应性增生淋巴结82枚。PTC转移淋巴结SWV平均值显著高于反应性增生淋巴结(P<0.001)。根据ROC分析结果,SWV平均值诊断界值为3.29 m/s,此时准确率为78.16%,特异性为78.05%,敏感度为78.26%。US-FNAB诊断准确率为86.21%,特异性为100.00%,敏感度为73.91%。VTIQ、US-FNAB及VTIQ联合US-FNAB对应的曲线下面积(area undercurve,AUC)分别为0.782、0.870、0.874,US-FNAB、VTIQ联合US-FNAB与VTIQ比较诊断效果差异有统计学意义(P<0.05),US-FNAB与VTIQ联合US-FNAB间诊断效果无统计学差异(P>0.05)。结论:VTIQ联合US-FNAB对于HT合并PTC颈部中央区肿大淋巴结性质的判定具有一定的应用价值。

Objective:To investigate the value of virtual touch tissue image quantification(VTIQ)technique combined with ultrasound-guided fine-needle aspiration biopsy(US-FNAB)in the differential diagnosis of lymph nodes in central cervical zone for papillary thyroid carcinoma(PTC)complicated with Hashimoto’s thyroiditis(HT).Methods:A total of 174 lymph nodes in central cervical zone in 125 PTC patients with HT received preoperative examination of VTIQ and US-FNAB confirmed by pathology were retrospectively analyzed.Transverse shear wave velocity(SWV)was measured to reflect VTIQ indicating the stiffness of the lymph nodes.The receiver operator characteristic(ROC)curve was used to find the best cut-off point of SWV.Lymph nodes was examined by cytological US-FNAB.The results of VTIQ,US-FNAB and VTIQ combined with US-FNAB were compared with postoperative pathology to compare their diagnostic effects.Results:174 lymph nodes in central cervical zone included 92 metastatic lymph nodes of PTC and 82 reactive lymph nodes.The mean SWV of PTC metastatic lymph nodes was significantly higher than those of reactive hyperplasia(P<0.001).According to ROC curve analysis,the cut-off value of SWV mean was 3.29 m/s.The accuracy,specificity and sensitivity were 78.16%,78.05%,78.26%.The accuracy,specificity and sensitivity of US-FNAB were 86.21%,100.00%,73.91%.The area under the curve(AUC)of VTIQ,US-FNAB and VTIQ combined with US-FNAB were 0.782,0.870,0.874,respectively.A difference in diagnostic performance was present when the US-FNAB or VTIQ combined with US-FNAB compared with VTIQ only(P<0.05),while no difference between US-FNAB and VTIQ combined with US-FNAB(P>0.05).Conclusion:VTIQ technique combined with US-FNAB has important application value in the differential diagnosis of lymph nodes in central cervical zone for PTC complicated with HT.