桥本甲状腺炎超声与病理学诊断的一致性分析

Analysis of consistency between ultrasound and pathological diagnosis of Hashimoto thyroiditis

目的 探讨超声检查与组织病理学检查诊断桥本甲状腺炎的一致性。方法 收集2016年1月-2020年12月在解放军总医院第一医学中心因甲状腺结节行手术治疗的6238例患者的临床资料进行回顾性分析,所有患者术前甲状腺功能及超声检查资料完整,术后病理诊断明确。分析超声影像诊断桥本甲状腺炎的效能,并通过Cohen的Kappa系数(κ)评估超声与病理诊断的一致性。根据术前促甲状腺激素(TSH)水平将患者分为TSH升高组(n=329)、TSH正常组(n=5662)及TSH降低组(n=247),探讨在术前不同甲状腺功能状态下超声检查的诊断效能,以及与病理学诊断的一致性。结果 (1)6238例患者中,术前超声检查提示桥本甲状腺炎1549例,术后病理诊断桥本甲状腺炎1182例;超声及病理学诊断均阳性的患者仅687例(58.1%)。确诊患者中女性占88.7%(1048/1182),男性占11.3%(134/1182);女性中3种典型超声表现[实质回声减低(17.9%vs.11.8%)、网格样改变(7.5%vs.4.7%)、血流增加(14.5%vs.8.3%),P<0.001]以及超声诊断阳性率(27.8%vs. 17.1%,P<0.001)、病理诊断阳性率(23.3%vs. 7.7%,P<0.001)均明显高于男性。(2)一致性分析提示,超声诊断与病理诊断的一致性为一般(κ=0.367)。超声诊断的敏感度为58.1%,特异度为83.0%,阳性预测值为44.4%,阴性预测值为89.4%,准确度为78.2%,其中,单一超声特征(实质回声减低、网格样改变、血流增加)在诊断时的敏感度分别为33.2%、22.0%、28.8%,特异度分别为87.8%、96.9%、91.0%,阳性预测值分别为38.8%、62.4%、42.7%,阴性预测值分别为84.9%、84.2%、84.5%,准确度分别为77.4%、82.7%、79.2%。受试者工作特征(ROC)曲线分析提示,单一超声特征或两种超声特征相结合在诊断时的预测性均较差,其中,实质回声减低及实质回声减低结合网格样改变在诊断时的表现稍好。(3)术前TSH升高组、TSH降低组的超声及病理诊断阳性率较高(TSH升高组分别为57.9%、52.2%,TSH降低组分别为33.7%、15.5%),而TSH正常组则偏低(分别为22.9%、17.7%)。此外,TSH升高组中超声与病理诊断的一致性相对最好,接近中等程度(κ=0.399)。结论 超声诊断及单一影像学特征在诊断桥本甲状腺炎时的特异度良好而敏感度欠佳。超声诊断与病理诊断的一致性程度一般,联合术前TSH升高时二者的一致性稍增强,但仅可作为参考。女性患者出现甲状腺功能异常时,联合超声诊断的价值更高。超声检查是桥本甲状腺炎的一项方便、快捷的支持性诊断方法。

Objective To explore the consistency of ultrasonography and histopathology in diagnosis of Hashimoto thyroiditis.Methods The clinical data of 6238 patients,who underwent surgical treatment for thyroid nodules in the First Medical Center of Chinese PLA General Hospital from January 2016 to December 2020,were collected and retrospectively analyzed.The preoperative thyroid function and ultrasound examination data of the included patients were complete,and the postoperative pathological results were clear.The effectiveness of ultrasound imaging in diagnosis of Hashimoto thyroiditis was analyzed,and the consistency between ultrasound and pathological diagnosis was evaluated by use of Cohen's kappa coefficient(κ).According to the preoperative thyroid stimulating hormone(TSH)level,the patients were divided into TSH elevated group(n=329),TSH normal group(n=5662)and TSH decreased group(n=247).The diagnostic efficacy of ultrasound examination under different preoperative thyroid function states and its consistency with pathological diagnosis were discussed.Results(1)Among the 6238 patients,preoperative ultrasound examination revealed 1549 cases of Hashimoto thyroiditis,and postoperative pathological diagnosis revealed 1182 cases of Hashimoto thyroiditis;Only 687 patients(58.1%)had positive ultrasound and pathological diagnoses.Among the confirmed patients,88.7%were women(1048/1182)and 11.3%were men(134/1182);The three typical ultrasound manifestations in women,including reduced parenchymal echo(17.9%vs.11.8%),grid like changes(7.5%vs.4.7%),increased blood flow(14.5%vs.8.3%,P<0.001),as well as the positive rate of ultrasound diagnosis(27.8%vs.17.1%,P<0.001)and pathological diagnosis(23.3%vs.7.7%,P<0.001),were significantly higher than those in men.(2)Consistency analysis showed that the consistency between ultrasound diagnosis and pathological diagnosis was general(κ=0.367).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ultrasound diagnosis were 58.1%,83.0%,44.4%,89.4%and 78.2%,respectively.The sensitivity,specificity,positive predictive value and negative predictive value of single imaging features(reduced parenchymal echo,grid like changes and increased)were 33.2%,22.0%,28.8%,87.8%,96.9%,91.0%,38.8%,62.4%,42.7%and 84.9%,84.2%,84.5%,respectively.The accuracy was 77.4%,82.7%and 79.2%,respectively.Receiver operating characteristic(ROC)curve analysis showed that the predictive value of single imaging feature or the combination of two imaging features was poor in diagnosis.Among them,reduced parenchymal echo and reduced parenchymal echo combined with grid like changes were slightly better in diagnosis.(3)The positive rates of ultrasound and pathological diagnosis were higher in preoperative TSH elevated group and TSH decreased group(57.9%and 52.2%respectively in TSH elevated group;and 33.7%and 15.5%respectively in TSH decreased group,while TSH normal group was lower(22.9%and 17.7%,respectively).In addition,the consistency between ultrasound and pathological diagnosis in elevated TSH group was relatively the best,close to moderate(κ=0.399).Conclusions Both ultrasound diagnosis and single imaging features have good specificity and poor sensitivity in the diagnosis of Hashimoto thyroiditis.The consistency between ultrasound diagnosis and pathological diagnosis is general,and the consistency is slightly enhanced when combined with preoperative TSH elevation,but it can only be used as a reference.For female patients having thyroid dysfunction;the significance of combined ultrasound diagnosis will be greater.Ultrasonography is a convenient and quick supportive diagnosis of Hashimoto's thyroiditis.