C-TIRADS分类联合SWE用于FNA不明确甲状腺结节鉴别中的价值

The Value of C-TIRADS Classification Combined with SWE in the Differential Diagnosis of FNA Ambiguous Thyroid Nodules

目的:探究中国超声甲状腺影像报告和数据系统(C-TIRADS)分类联合剪切波弹性成像(SWE)用于超声引导下细针抽吸活检(FNA)诊断不明确甲状腺结节中的鉴别诊断价值。方法:回顾性收集并分析FNA不明确甲状腺结节204例患者的临床资料、影像学资料及手术病理资料,以手术病理结果为金标准,比较C-TIRADS分类、SWE及二者联合对FNA不明确甲状腺结节的鉴别诊断价值。结果:经术后病理证实,204例患者244个结节中良性结节78个、恶性结节166个;C-TIRADS分类判定恶性结节154个、良性结节90个,诊断灵敏度、特异度为84.34%和82.05%;病理结果诊断的良、恶性结节间平均SWE Emax比较差异有统计学意义(P<0.05);ROC曲线表明SWE Emax最佳截断值为46.3 Kpa时,其对FNA不明确甲状腺结节的诊断灵敏度、特异度分别为77.11%和87.18%;C-TIRADS分类联合SWE Emax诊断灵敏度、特异度分别为93.98%和87.18%,诊断效能高于单一方法诊断。结论:C-TIRADS分类联合SWE应用于FNA不明确甲状腺结节鉴别中可进一步提高诊断效能。

Purpose:To explore the differential diagnostic value of C-TIRADS classification combined with shear wave elastography(SWE) in ultrasound guided fine-needle aspiration biopsy(FNA) for the diagnosis of uncertain thyroid nodules.Materials and Methods:The clinical data,imaging data and surgical and pathological data of 204 patients with FNA unclear thyroid nodules were retrospectively collected and analyzed,Taking the surgical and pathological results as the gold standard,To compare the value of C-TIRADS classification,SWE and their combination in the differential diagnosis of FNA indeterminate thyroid nodules.Results:It was confirmed by pathology after operation,among 244 nodules in 204 patients,78 were benign and 166 were malignant;C-TIRADS classified 154 malignant nodules and 90 benign nodules,with diagnostic sensitivity and specificity of 84.34% and 82.05%;The average SWE Emax between benign and malignant nodules diagnosed by pathology was statistically significant(P<0.05);The ROC curve showed that when the optimal cut-off value of SWE Emax was 46.3 Kpa,the sensitivity and specificity of SWE Emax in the diagnosis of FNA unclear thyroid nodules were 77.11% and 87.18% respectively;The sensitivity and specificity of C-TIRADS classification combined with SWE Emax were 93.98% and 87.18% respectively,and the diagnostic efficacy was higher than that of single method.Conclusion:The application of C-TIRADS classification combined with SWE in the differential diagnosis of FNA ambiguous thyroid nodules can further improve the diagnostic efficiency.