三维断层超声成像评估甲状腺微小乳头状癌腺体外侵犯

Evaluation of Extrathyroidal Extension of Papillary Thyroid Microcarcinoma With Three-Dimensional Tomographic Ultrasound Imaging

目的探讨三维断层超声成像(3D-TUI)在评估甲状腺微小乳头状癌腺体外侵犯(ETE)中的价值。方法纳入2016年2月至2018年1月北京协和医院79例甲状腺微小乳头状癌患者的97个结节,由2名超声科医师采用盲法评估二维超声(2D-US)及3D-TUI甲状腺结节与被膜的关系,以术中所见及术后病理结果为ETE诊断金标准,比较2D-US和3D-TUI评估ETE的诊断效能。结果97个结节中,54个(55.7%)伴有ETE。3D-TUI诊断甲状腺微小乳头状癌ETE的敏感度(68.5%比37.0%;χ^(2)=10.737,P=0.002)、准确率(74.5%比56.7%;χ^(2)=6.686,P=0.015)和受试者工作特性曲线下面积[0.761(95%CI=0.677~0.845)比0.592(95%CI=0.504~0.680);Z=3.500,P<0.001]高于2D-US,而特异度(84.1%比81.4%;χ^(2)=0.081,P=0.776)、阴性预测值(67.9%比50.7%;χ^(2)=3.645,P=0.066)、阳性预测值(84.1%比71.4%;χ^(2)=1.663,P=0.240)两者差异无统计学意义。结论3D-TUI较2D-US对甲状腺微小乳头状癌ETE具有更好的诊断效能。

Objective To evaluate extrathyroidal extension(ETE)in papillary thyroid microcarcinoma(PTMC)with three-dimensional tomographic ultrasound imaging(3D-TUI).Methods A total of 97 thyroid nodules of 79 patients with PTMC treated in PUMC Hospital from February 2016 to January 2018 were included in this study.Two ultrasound experts performed independent blinded assessment of the relationship between thyroid nodules and thyroid capsule by two-dimensional ultrasound(2D-US)and 3D-TUI.The results of 2D-US and 3D-TUI in evaluating ETE were compared with intraoperative findings and postoperative histological and pathological results.Results Among the 97 nodules,54(55.7%)nodules had ETE.The diagnostic sensitivity(68.5%vs.37.0%;χ^(2)=10.737,P=0.002),accuracy(74.5%vs.56.7%;χ^(2)=6.686,P=0.015),and area under the receiver operating characteristic curve[0.761(95%CI=0.677-0.845)vs.0.592(95%CI=0.504-0.680);Z=3.500,P<0.001]of 3D-TUI were higher than those of 2D-US.However,3D-TUI and 2D-US showed no significant difference in the specificity(84.1%vs.81.4%;χ^(2)=0.081,P=0.776),negative predictive value(67.9%vs.50.7%;χ^(2)=3.645,P=0.066),or positive predictive value(84.1%vs.71.4%;χ^(2)=1.663,P=0.240).Conclusion Compared with 2D-US,3D-TUI demonstrates increased diagnostic efficiency for ETE of PTMC.