超声弹性成像联合US-FNAB诊断TI-RADS 4类甲状腺结节的价值探讨

The Value of Ultrasound Elastography Combined with US-FNAB in Diagnosing TI-RADS Type 4 Thyroid Nodules

目的:探讨超声弹性成像(UE)联合超声引导下细针穿刺活检(US-FNAB)对甲状腺影像报告与数据系统(TI-RADS)4类甲状腺结节的诊断价值。方法:回顾性分析2021年1月至2023年3月于我院手术切除的96例术前超声分类为TI-RADS 4类甲状腺结节患者的临床资料,患者术前均接受UE和US-FNAB检查;以术后病理结果为金标准,使用Kappa一致性检验评价UE、US-FNAB联合诊断TI-RADS 4类甲状腺结节良、恶性的价值。结果:经术后病理证实共有恶性结节68例(70.83%),良性结节28例(29.17%);恶性结节和良性结节的弹性评分分布有统计学差异(P<0.05);术前UE诊断恶性结节59例,良性结节37例;术前US-FNAB诊断恶性结节66例,良性结节30例;UE、US-FNAB、UE联合US-FNAB串联试验诊断结节良、恶性与病理结果一致性一般(Kappa=0.608、0.704、0.492),UE联合US-FNAB并联试验诊断结节良、恶性与病理结果一致性较好(Kappa=0.761)。结论:术前UE联合US-FNAB(并联试验)对TI-RADS 4类甲状腺结节的诊断具有高度敏感性,有助于减少甲状腺癌的漏诊。

Purpose:To explore the diagnostic value of ultrasonic elastography(UE)combined with ultrasoundguided fine needle aspiration biopsy(US-FNAB)in thyroid image reporting and data system(TI-RADS)type 4thyroid nodules.Methods:Clinical data of 96 patients with preoperative ultrasound classification of TI-RADS type 4thyroid nodules who underwent surgical resection in our hospital from January 2021 to March 2023 were retrospective analyzed.All the patients underwent UE and US-FNAB before surgery.Taking pathological results as golden standard,the diagnostic value of UE,US-FNAB and combined detection for benign and malignant TI-RADS type 4 thyroid nodules were evaluated by Kappa consistency test.Results:Among the 96 patients with TI-RADS type 4 thyroid nodules,pathological examination showed that there were 68 cases(70.83%)with malignant nodules and 28 cases(29.17%)with benign nodules.There were significant differences in the distribution of elastography scores between malignant and benign nodules(P<0.05).UE showed that there were 59 cases with malignant nodules and 37cases with benign nodules.US-FNAB showed that there were 66 cases with malignant nodules and 30 cases with benign nodules.The consistency between UE,US-FNAB,UE combined with US-FNAB(tandem test)and pathological examination were not bad in the diagnosis of benign and malignant TI-RADS type 4 thyroid nodules(Kappa=0.608,0.704,0.492,respectively),while the consistency between UE combined with US-FNAB(parallel test)and pathological examinationwere good(Kappa=0.761).Conclusion:Preoperative UE combined with USFNAB(parallel test)has high sensitivity in the differential diagnosis of TI-RADS type 4 thyroid nodules,which is beneficial to reduce the missed diagnosis of thyroid cancer.