超声在甲状腺良、恶性病变鉴别诊断中的效能研究

Diagnostic efficacy of ultrasound in the differential diagnosis of benign and malignant thyroid lesions

目的 分析甲状腺良、恶性病变鉴别诊断中超声的诊断效能。方法 选择2020年4月至2022年4月接诊的60例甲状腺结节患者,分别给予二维超声、彩色多普勒超声检查,将术后病理诊断作为本研究的金标准,对比二维超声、彩色多普勒超声诊断准确率、灵敏度、特异度,Kappa检验二维超声、彩色多普勒超声与金标准的一致性。对比良、恶性病灶组超声声像图特征、彩色血流分型、血流参数。结果 彩色多普勒超声诊断准确率(83.33%)、灵敏度(75.00%)均高于二维超声(58.33%、5.00%)(P<0.05),二维超声特异度(85.00%)与彩色多普勒超声(95.00%)比较,差异无统计学意义(P>0.05),二维超声与金标准的一致性一般(Kappa值=0.585),彩色多普勒超声与金标准的一致性较好(Kappa值=0.786)。恶性组回声不均匀率(58.82%)、形态不规则率(64.71%)、细小点状钙化率(70.59%)、边缘不清晰率(70.59%)、后方衰减率(81.35%)、纵横比≥1率(64.71%)均高于良性组,差异均有统计学意义(P<0.05)。恶性组Ⅰ级(58.82%)、Ⅱ级率(41.18%)均高于良性组的23.26%、0,差异均有统计学意义(P<0.05)。恶性组RI、Vmax均高于良性组,(P<0.05)。结论 彩色多普勒超声可提高甲状腺良、恶性病变鉴别诊断准确率、灵敏度,同时提供声像图、血流分型、血流参数等信息,临床参考价值较高。

Objective To analyze the diagnostic efficacy of ultrasound in the differential diagnosis of benign and malignant thyroid lesions.Methods A total of 60 patients with thyroid nodules admitted to our hospital from April 2020 to April 2022 were selected.They were examined with two-dimensional ultrasonography and color Doppler ultrasonography.The postoperative pathological diagnosis was taken as the gold standard of this study.The accuracy,sensitivity,specificity,and Kappa value of two-dimensional ultrasonography and color Doppler ultrasonography in the differential diagnosis of benign and malignant thyroid lesions were compared,and their diagnostic results agreed with that of the gold standard were compared.Ultrasound sonographic features,color flow classification,and blood flow parameters of benign and malignant thyroid lesions were compared.Results The diagnostic accuracy(83.33%vs 58.33%)and sensitivity(75.00%vs 5.00%)of color Doppler ultrasonography were significantly higher than those of two-dimensional ultrasonography(P<0.05).There was no significant difference in the specificity of two-dimensional ultrasonography and color Doppler ultrasonography in the differential diagnosis of benign and malignant thyroid lesions(85.00%vs 95.00%,P>0.05).The agreement of two-dimensional ultrasonography with the gold standard was general(Kappa value=0.585),and that of color Doppler ultrasonography was high(Kappa value=0.786).In the malignant group,the echo uneven rate(58.82%vs 18.60%),irregular shape rate(64.71%vs 30.23%),small point calcification rate(70.59%vs 23.26%),unclear edge rate(70.59%vs 27.91%),posterior attenuation rate(81.35%vs 41.86%),and aspect ratio≥1 rate(64.71%vs 32.56%)were all significantly higher than those of benign group(all P<0.05).The rates of gradeⅠ(58.82%vs 23.26%)and gradeⅡ(41.18%vs 0)in the malignant group were significantly higher than those of the benign group(P<0.05).Resistive index(RI)and maximum flow velocity(Vmax)in malignant group were significantly higher than those of benign group(P<0.05).Conclusion Color Doppler ultrasound can improve the accuracy and sensitivity of the differential diagnosis of benign and malignant thyroid lesions,which provides information like sonography,blood flow classification,and blood flow parameters.It has a high clinical reference value.