甲状腺结节及其旁组织弹性定量特征对结节良恶性诊断价值的研究

Research on the value of elasticity quantitative characteristics of thyroid nodules and paratubercular thyroid tissue in differential diagnosis of benign and malignant thyroidnodules

目的探讨甲状腺结节及其旁甲状腺组织弹性定量特征在辅助诊断甲状腺结节良恶性方面的临床价值。方法选取2018年9月~2021年12月于我院行甲状腺结节切除术的患者140例,共140个结节,其中甲状腺癌组(TC组)66个、非甲状腺癌组(非TC组)74个,应用实时剪切波弹性成像技术(SWE)对结节及结节旁甲状腺组织弹性参数进行测量,记录E_(max)结节、E_(mean)结节、E_(min)结节、E_(sd)结节,E_(max)结节旁、E_(mean)结节旁、E_(min)结节旁、E_(sd)结节旁,并进行分析比较。结果TC组E_(max)结节、E_(mean)结节、E_(min)结节、E_(sd)结节,E_(max)结节旁、E_(mean)结节旁、E_(min)结节旁值均大于非TC组,差异有统计学意义(P<0.05);相关分析显示E_(max)结节、E_(mean)结节、E_(min)结节、E_(sd)结节,E_(max)结节旁、E_(mean)结节旁、E_(min)结节旁值与结节良恶性呈负相关,差异有统计学意义(P<0.05);以病理结果为诊断“金标准”,构建各超声参数诊断结节良恶性的ROC曲线,结果显示除E_(sd)结节旁外,余参数曲线下面积均>0.7,根据约登指数,当取其诊断界值时,E_(max)结节与E_(mean)结节的灵敏度及特异度最高,均分别为81.8%与78.4%;当设定特异度均为100%时,E_(mean)结节的最高灵敏度最高,为48.5%。结论基于SWE技术的甲状腺结节及结节旁甲状腺组织的弹性定量特征在辅助鉴别诊断结节良恶性方面有一定的临床价值,其中E_(mean)结节的诊断价值较高。

Objective To investigate the value of quantitative elastic characteristics of thyroid nodules and thyroid tissue adjacent to thyroid nodules in the auxiliary diagnosis of benign and malignant thyroid nodules.Methods 140 patients(140 nodules)who were hospitalized in our hospital for thyroid nodule resection from September 2018 to December 2021 were selected and divided into thyroid cancer group(TC group,66cases)and non thyroid cancer group(non TC group,74cases)according to the postoperative pathological results,Real time shear wave elastography(SWE)was used to measure the elastic parameters of thyroid nodules and thyroid tissue adjacent to nodules.The E_(max) nodules、E_(mean) nodules、E_(min) nodules、E_(sd) nodules;E_(max) thyroid tissue adjacent to nodules、E_(mean) thyroid tissue adjacent to nodules、E_(min) thyroid tissue adjacent to nodules、E_(sd) thyroid tissue adjacent to nodules were recorded and analyzed.Results The E_(max) nodules、E_(mean) nodules、E_(min) nodules、E_(sd) nodules;E_(max) thyroid tissue adjacent to nodules、E_(mean) thyroid tissue adjacent to nodules、E_(min) thyroid tissue adjacent to nodules in TC group were higher than those in non TC group,the difference was statistically significant(P<0.05);The E_(max) nodules、E_(mean) nodules、E_(min) nodules、E_(sd) nodules;E_(max) thyroid tissue adjacent to nodules、E_(mean) thyroid tissue adjacent to nodules、E_(min) thyroid tissue adjacent to nodules were negatively correlated with the benign and malignant nodules,the differences were statistically significant(P<0.05);pathological results were used as the"gold standard"for diagnosis,the ROC curves of ultrasonic parameters in the diagnosis of benign and malignant nodules were constructed,the results showed that the areas under the curve were all>0.7 except E_(sd) thyroid tissue adjacent to nodules,according to the Youden index,when taking its diagnostic limit,the sensitivity and specificity of E_(max) nodules and E_(mean) nodules were the highest,which was 81.8%and 78.4%respectively;When the specificity was set to 100%,the highest sensitivity of E_(mean) nodules is the highest,which was 48.5%.Conclusion The elastic quantitative characteristics of thyroid nodules and thyroid tissue adjacent to thyroid nodules based on SWE has certain clinical value in the differential diagnosis of benign and malignant thyroid nodules,and the diagnostic value of E_(mean) nodules is higher.