二维超声联合微血管成像技术对甲状腺微小结节良恶性的诊断及预测价值

Diagnostic and Predictive Value of Two-dimensional Ultrasound Combined with Superb Micro-vascular Imaging in Benign and Malignant Thyroid Tiny Nodules

目的探讨二维超声(2D)联合微血管成像技术(SMI)预测恶性结节侵袭性的价值。方法选取宁夏医科大学总医院肿瘤外科进行甲状腺手术145例患者共162个微小结节。术前进行二维及SMI模式下超声检查,观察每个结节的血流分布特征、同一切面两种模式下面积的大小,与其超声引导下细针活检穿刺(US-FNAB)及术后病理组织对照,得出微小结节良、恶性血流分布特征;ROC曲线分析两种超声模式联合在微小恶性结节向周围组织侵袭的最佳临界值及灵敏度、特异度。结果1)术后病理结果:162个微小结节中良性结节31个、恶性结节131个。2)SMI模式下结节血流分布特征:汇聚征、空洞征多为恶性结节;其他征多为良性结节;三种血流分布征象在恶性组与良性组中例数差异有统计学意义(χ^(2)=57.414,P<0.001)。3)微小结节在同一切面的2D与SMI模式下测量面积比较:良性结节两种模式下面积大小差异无统计学意义(Z=-0.040,P=0.968);恶性结节SMI模式下面积>2D模式(Z=-4.723,P<0.001)。4)SMI模式下面积>2D面积的结节82个;面积有差异的部位均进行US-FNAB,病理结果提示有癌细胞侵袭的结节50个。SMI面积/2D面积法鉴别甲状腺微小恶性结节具有侵袭性的ROC曲线下面积为0.878(P<0.001),最佳临界值为1.67,诊断恶性结节向周围侵袭的灵敏度为64.8%,特异度为83.2%。结论2D超声联合SMI可预测恶性结节是否具有侵袭性。

Objective To explore the value of two dimensional ultrasound(2D)combined with superb micro-vascular imaging(SMI)combined to predict the invasion of malignant nodules.Methods A total of 162 micronodules were selected from 145 patients who underwent thyroid surgery in oncology surgery in General Hospital of Ningxia Medical University.Before operation,two-dimensional and SMI mode ultrasound examination was performed to observe the blood flow distribution characteristics of each node and the size of the area under the two modes of the same section,and compared with the ultrasound-guided fine-needle aspiration biopsy(US-FNAB)and postoperative pathological tissue.The distribution characteristics of benign and malignant blood flow were obtained.The best critical value,sensitivity and specificity of the combination of the two ultrasound modes in the diagnosis of the invasion of small malignant nodules to surrounding tissues.Results 1)Postoperative pathological results:31 benign nodules and 131 malignant nodules out of total 162 micronodules.2)SMI mode:benign,malignant nodding blood flow distribution characteristics were compared,"convergence sign"and"hollow sign"were mostly malignant nodules;"other signs"were mostly benign nodules.The difference of three patterns of blood flow distribution between the malignant group and the benign group was statistically significant(χ^(2)=57.414,P<0.001).3)The area size of benign and malignant nodules was compared in two-dimensional and SMI modes.US-FNAB of thyroid tiny nodules was performed in all the sites with different areas.There was no significant difference in benign nodules(Z=-0.040,P=0.968).Compared with the size of the malignant nodules,the measured value in SMI mode was significantly larger than the measured value under the two-dimensional graph(Z=-4.723,P<0.001).4)82 thyroid nodules were larger than 2D nodules in SMI mode,the pathological results showed that there were 50 nodules invaded by cancer cells on the sites with different areas under the two modes.The area in SMI mode/the area in two-dimensional method to identify whether the thyroid micro-malignant nodules immersed in surrounding tissue had an area of 0.878 under the trend ROC curve(P<0.001),it was statistically significant.The optimal critical value was 1.67,the sensitivity to diagnosis of malignant nodules to the surrounding immersion was 64.8%,and the specificity was 83.2%.Conclusion 2D ultrasound combined with SMI can predict the invasion of malignant nodules.