探讨健康体检中超声弹性成像应变比值鉴别甲状腺结节良恶性的价值

Exploring the value of strain ratio of ultrasonic elastography in distinguishing benign and malignant thyroid nodules in health examinations

目的:探索超声弹性成像应变比值(SR)与常规超声在健康体检中鉴别甲状腺(ACR TI-RADS 4类及以上)结节良恶性的价值。方法:回顾性分析2020年1月1日—2022年12月31日本院健康体检的甲状腺结节(ACR TI-RADS 4类及以上)患者,针对经术后或穿刺病理证实的79个甲状腺结节同时进行常规超声检查(拟定ACR TI-RADS评分5分及以上考虑恶性)和超声弹性成像SR检查,阈值为2.73,以病理结果为金标准,构建受试者工作特征ROC曲线,分析曲线下面积(AUC),评价两种方法在健康体检中鉴别诊断甲状腺结节良恶性的价值。结果:经病理证实79个结节(恶性52个,良性27个)。超声弹性成像SR和常规超声鉴别诊断甲状腺(ACR TI-RADS 4类及以上)结节良恶性的灵敏度、特异度、准确性、阳性预测值、阴性预测值分别为:92.31%、88.89%、91.14%、94.12%、85.71%;67.30%、62.96%、65.82%、77.78%、50.0%。超声弹性成像SR组和常规超声组曲线下AUC分别为0.906和0.651,两种方法测值比较,差异具有统计学意义(P<0.05)。结论:健康体检中超声弹性成像SR在ACR TI-RADS 4类及以上甲状腺结节中鉴别诊断结节良、恶性比常规超声组准确性高。

Objective:To explore the value of ultrasound elastography strain ratio(SR) and conventional ultrasound in differentiating benign and malignant thyroid nodules(ACR TI-RADS 4 and above) in healthy physical examination.Methods:A retrospective analysis was conducted on patients with thyroid nodules(ACR TI-RADS 4 and above) who underwent health examinations at the hospital from January 1,2020 to December 31,2022.A total of 79 thyroid nodules confirmed by postoperative or pathology underwent conventional ultrasound(with a proposed ACR TI-RADS score of 5 or above considering malignancy) and ultrasound elastography SR examination,with a threshold of 2.73.The pathological results were used as the gold standard to construct the receiver operating characteristic(ROC) curve,to analyze the area under the curve(AUC),and evaluate the value of the two methods in the differential diagnosis of benign and malignant thyroid nodules in physical examination.Results:Seventy-nine nodules(52 malignant and 27 benign) were confirmed by pathology.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of ultrasound elastography SR and conventional ultrasound in differential diagnosis of benign and malignant thyroid nodules(ACR TI-RADS 4 and above) were 92.31%,88.89%,91.14%,94.12%,85.71%;67.30%,62.96%,65.82%,77.78%,50.0%.The AUC of the ultrasound elastography SR group and the conventional ultrasound group were 0.906 and 0.651,respectively,and the difference was statistically significant(P<0.05).Conclusion:The SR of ultrasound elastography in physical examination is more accurate in the differential diagnosis of benign and malignant nodules in ACR TI-RADS 4 and above thyroid nodules than that in the conventional ultrasound group.