实时剪切波弹性成像结合超声量化评分在甲状腺结节良恶性鉴别诊断中的应用价值

The application value of real-time shear wave elastography combined with ultrasound quantitative score in differential diagnosis of benign and malignant thyroid nodules

目的探究实时剪切波弹性成像(SWE)结合超声量化评分在甲状腺结节良恶性鉴别诊断中的应用价值。方法回顾性分析2018年6月1日至2020年1月31日在合肥市第二人民医院行甲状腺B超检查的88例患者,其中男性17例,女性71例。分别采用常规二维超声多普勒和实时剪切波弹性成像的方法检测甲状腺结节,采用约登指数对常规超声检测结果进行评分,根据ROC曲线,认定诊断界点为3分,≥3分为恶性结节可能;<3分为良性结节可能。采用约登指数对SWE进行,根据ROC曲线,认定诊断界点为46.1 kPa,≥46.1 kPa为恶性结节可能;<46.1 kPa为良性结节可能。记录2种检测方法诊断甲状腺结节的特异性敏感性阳性预测值和阴性预测值。结果116个甲状腺结节均经过细针穿刺细胞学检查得到病理诊断。其中良性结节有66个,恶性结节有50个。均以病理结果为金标准,绘制3种ROC曲线。超声量化评分的ROC曲线结果显示,95%可信区间即曲线下面积为0.722。常规超声预测甲状腺结节良恶性准确度为73.8%,敏感度为65.6%,特异度为83.4%,阳性预测值为86.4%,阴性预测值为63.1%。SWE ROC曲线结果显示,95%可信区间即曲线下面积为0.831。SWE预测甲状腺结节良恶性准确度为78.2%,敏感度为79.9%,特异度为88.3%,阳性预测值为90.1%,阴性预测值为67.4%。超声量化评分联合SWE ROC曲线结果显示,95%可信区间即曲线下面积为0.897。常规超声量化评分联合SWE预测甲状腺结节良恶性准确度为83.4%,敏感度为85.1%,特异度为92.7%,阳性预测值为93.5%,阴性预测值为78.9%。结论常规超声联合SWE可以提高甲状腺结节良恶性鉴别诊断的敏感度和特异度。

Objective To explore the application value of real-time shear wave elastography combined with ultrasound quantitative score in the differential diagnosis of benign and malignant thyroid nodules.Methods A retrospective analysis was made on 88 patients admitted to our hospital from July 2018 to January 2020,including 17 males and 71 females.Thyroid nodules were detected by conventional two-dimensional ultrasound Doppler detection and real-time shear wave elastography(SWE)respectively.The results of conventional ultrasound were scored by Yoden index.According to ROC curve,the diagnostic threshold was determined as 3 points,and≥3 points were classified as malignant nodules;<3 points as benign nodules.Real-time shear wave elastography was scored by Yoden index.According to the ROC curve,the diagnostic threshold was 46.1 kPa,≥46.1 kPa as malignant nodules and<46.1 kPa as benign nodules.The specificity,sensitivity,positive predictive value and negative predictive value of the two methods in the diagnosis of thyroid nodules were recorded.Results One hundred and sixteenth thyroid nodules were diagnosed by fine needle aspiration cytology.There were 66 benign nodules and 50 malignant nodules.Three ROC curve of ultrasound quantification score were drawn with pathological results as gold standard.The results showed that the 95%confidence interval,i.e.The area under the curve was 0.722.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of routine ultrasound in predicting benign and malignant thyroid nodules were 73.8%,65.6%,83.4%,86.4%and 63.1%,respectively.The SWE ROC curve was drawn.The results showed that the 95%confidence interval,i.e.the area under the curve,was 0.831.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of SWE for benign and malignant thyroid nodules were 78.2%,79.9%,88.3%,90.1%and 67.4%,respectively.The ultrasound quantitative score combined with SWE ROC curve was drawn.The results showed that the 95%confidence interval,i.e.the area under the curve,was 0.897.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of conventional ultrasound combined with SWE in predicting benign and malignant thyroid nodules were 83.4%,85.1%,92.7%,93.5%and 78.9%,respectively.Conclusion Conventional ultrasound combined with SWE can improve the sensitivity and specificity of the differential diagnosis between benign and malignant thyroid nodules.