多模态超声联合肿瘤标志物对甲状腺微小乳头状癌的诊断价值

Diagnostic value of multimodal ultrasound combined with tumor markers for papillary thyroid microcarcinoma

目的探讨多模态超声影像联合肿瘤标志物对甲状腺微小乳头状癌(PTMC)的诊断价值。方法回顾性分析福建省平潭综合实验区中医院170个甲状腺结节的多模态声像图(包括常规超声、常规超声联合超声造影、剪切波弹性成像和应变率弹性成像)和超声诊断。采用χ2检验比较PTMC常规超声和常规超声联合超声造影的诊断准确率。采用En Vision法进行免疫组织化学染色检测170个结节中的核增殖抗原(Ki-67);细胞表面糖蛋白56(CD56);细胞角质样蛋白19片段(CK19);半乳糖凝集素-3(Galectin-3)等4个肿瘤标志物,并分析肿瘤标志物的敏感度、特异度和准确度。采用Z检验比较多模态超声与多模态超声联合肿瘤标志的准确度、肿瘤标志物与肿瘤标志物联合多模态超声的准确度。结果常规超声联合超声造影对PTMC的诊断准确度高于常规超声(χ^(2)=6.19,P<0.025)。Ki-67敏感度、特异度、准确度分别是84.2%、82.0%、83.5%。CD56敏感度、特异度、准确度分别是84.2%、86.0%、84.7%。CK19敏感度、特异度、准确度分别是88.3%、84.0%、87.1%。Galectin-3的敏感度、特异度、准确度分别是72.5%、84.0%、75.9%。多模态超声联合肿瘤标志物诊断准确率高于多模态超声(Z=-4.69、-4.69、-4.46、-4.08;P均<0.01)。肿瘤标志物联合多模态超声的准确度高于肿瘤标志物(Z=-2.95,-3.26、-2.26、-107.6,P=0.002、<0.01、0.012、<0.01)。结论常规超声联合超声造影对PTMC具有更高的超声诊断准确度。多模态超声联合肿瘤标志物对PTMC的诊断准确率高于多模态超声,肿瘤标志物联合多模态超声可以避免肿瘤标志物的假阳性和假阴性诊断,推荐超声医生、临床医生及病理科医生应用多模态超声联合肿瘤标志物对PTMC进行诊断。

Objective To investigate the diagnostic value of multimodal ultrasound combined with tumor markers for papillary thyroid microcarcinoma(PTMC).Methods Multimembrane ultrasonography(including conventional ultrasound,conventional ultrasound combined with contrast-enhanced ultrasound,shear-wave elastography and strain-rate elastography)and ultrasonic diagnoses of 170 thyroid nodules from Traditional Chinese Medicine Hospital of Pingtan were retrospectively analyzed.The Chi-square test was used to compare the diagnostic accuracy of conventional ultrasound and conventional ultrasound combined with contrast-enhanced ultrasound in PTMC.En Vision method was used to detect four tumor markers(Ki-67,CD56,CK19,galectin-3)in 170 nodules,and the sensitivity,specificity and accuracy of tumor markers were analyzed.Z test was used to compare the accuracy of multimodal ultrasound and multimodal ultrasound combined with tumor markers,and the accuracy of tumor markers and tumor markers combined with multimodal ultrasound.Results Conventional ultrasound combined with contrast-enhanced ultrasound had a higher diagnostic accuracy in PTMC than conventional ultrasound(χ^(2)=6.19,P<0.025),which was statistically significant.The sensitivity,specificity and accuracy of Ki-67 were 84.2%,82.0%and 83.5%,respectively.The sensitivity,specificity and accuracy of CD56 were 84.2%,86.0%and 84.7%,respectively.CK19 sensitivity,specificity and accuracy were 88.3%,84.0%and 87.1%,respectively.Galectin-3 sensitivity,specificity,and accuracy were 72.5%,84.0%and 75.9%,respectively.The diagnostic accuracy of multimodal ultrasound combined with tumor markers was higher than that of multimodal ultrasound(Z=-4.69、-4.69、-4.46、-4.08;P<0.01).The accuracy of multimodal ultrasound combined with tumor markers was higher than that of tumor markers(Z=-2.95,-3.26、-2.26、-107.6,P=0.002、<0.01、0.012、<0.01).Conclusion Conventional ultrasound combined with contrast-enhanced ultrasound has higher diagnostic accuracy for PTMC.The diagnostic accuracy of multimodal ultrasound combined with tumor markers is higher than that of multimodal ultrasound for PTMC.Tumor markers combined with multimodal ultrasound can avoid false positive and false negative diagnosis of tumor markers,and it is recommended that multrasonographers,clinicians,and pathologists should apply multimodal ultrasound combined with tumor markers for the diagnosis of PTMC.