剪切波弹性成像联合超声造影对甲状腺微小乳头状癌侵袭性的价值研究

Value of shear wave elastography combined with contrast-enhanced ultrasound in diagnosing the invasiveness of papillary thyroid microcarcinoma

目的研究剪切波弹性成像(SWE)联合超声造影(CEUS)对甲状腺微小乳头状癌(PTMC)侵袭性的诊断价值,并分析PTMC侵袭性危险因素。方法选择汾阳医院2019年1月至2021年6月收治的接受手术治疗且经病理证实为PTMC的200例患者,术前进行SWE联合CEUS诊断,探究其对PTMC侵袭性的诊断价值,并收集患者资料分析PTMC侵袭性危险因素。结果经病理证实,200例PTMC患者中恶性结节112例,良性结节88例,颈部淋巴结转移75例(合并71例被膜侵犯),无淋巴结转移125例。恶性结节超声造影各项指标均显著高于良性结节(P>0.05)。SWE联合CEUS诊断PTMC淋巴结转移患者被膜侵犯灵敏度为94.66%,特异度为85.60%,准确度为89.00%,阳性预测值为79.77%,阴性预测值为96.39%,与病理结果高度一致(Kappa值>0.75)。经多因素Logistic回归分析得到多发灶、形态不规则、突破被膜、细小钙化是PTMC具有侵袭性的独立危险因素,且方差膨胀系数<3。受试者工作特征曲线结果显示SWE联合CEUS诊断曲线下面积为0.772,诊断灵敏度为73.91%,特异度为80.56%,具有较高诊断价值。结论SWE联合CEUS诊断可以显著提高PTMC侵袭性诊断准确度,对PTMC侵袭性预测有重要临床价值。

Objective To study the value of shear wave elastography(SWE)combined with contrast-enhanced ultrasound(CEUS)in diagnosing the invasiveness of papillary thyroid microcarcinoma(PTMC),and analyze its risk factors.Methods This study included 200 patients with pathologically confirmed PTMC who underwent surgery in Fenyang Hospital from January 2019 and June 2021.All were diagnosed with SWE and CEUS before surgery.The value of the two methods in diagnosing the invasiveness of PTMC was explored.The patients′data were collected to screen the risk factors for the invasiveness of PTMC.Results It was pathologically confirmed that among the 200 patients with PTMC,there were 112 cases with malignant nodules,88 cases with benign nodules,75 cases with cervical lymph node metastasis(including 71 cases with capsular invasion)and 125 cases without lymph node metastasis.CEUS parameters of malignant nodules were significantly higher than those of benign nodules(P<0.05).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of SWE combined with CEUS to diagnose capsular invasion were 94.66%,85.60%,89.00%,79.77%and 96.39%,with high consistency with the pathological results(Kappa>0.75).Multivariate Logistic regression analysis showed that multiple foci,irregular shape,breakthrough capsule and small calcification were independent risk factors for the invasiveness of PTMC(VIF<3).The ROC curve results showed that the AUC of SWE combined with CEUS to diagnose capsular invasion was 0.772,and the diagnostic sensitivity and specificity were 73.91%and 80.56%.Conclusions SWE combined with CEUS can significantly improve the diagnostic accuracy for the invasiveness of PTMC.