常规超声联合超声造影对甲状腺部分囊性结节的诊断价值

Diagnostic value of conventional ultrasound combined with contrast-enhanced ultrasound in cystic solid thyroid nodule

目的:探讨常规超声联合超声造影对甲状腺部分囊性结节(partially cystic thyroid nodule,PCTN)的诊断价值。方法:回顾并分析2018年1月—2022年8月经超声检出为PCTN并经细针穿刺或术后病理学检查确诊的252例患者的资料。所有患者为单发结节,术前均接受超声造影检查。以病理学检查结果为金标准,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,比较超声造影、常规超声及两者联合的诊断效能。结果:252个结节中良性结节189个,恶性结节63个,常规超声、超声造影诊断PCTN的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为82.0%、88.9%、84.1%、95.7%、62.2%和89.9%、85.7%、88.9%、94.9%、73.9%,曲线下面积(area under curve,AUC)分别为0.854、0.878。联合诊断后灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为95.8%、84.1%、92.9%、94.8%、86.9%,AUC为0.899,明显高于单一的诊断方式(P<0.05)。结论:常规超声及超声造影对PCTN具有较高的诊断效能,两者联合应用能提高诊断灵敏度、准确度、阴性预测值,有助于指导PCTN的治疗与管理。

Objective:To investigate the diagnostic value of conventional ultrasound combined with contrast-enhanced ultrasound in the diagnosis of partially cystic thyroid nodule(PCTN).Methods:A retrospective analysis was performed on 252 patients with PCTN detected by ultrasound and pathological results obtained by fine-needle puncture or surgical operation from January 2018 to August 2022.All patients were single nodules.All patients underwent contrast-enhanced ultrasound examination before surgery.With pathological results as the gold standard,receiver operating characteristic(ROC)curve was drawn to compare the diagnostic efficacy of contrast-enhanced ultrasound,conventional ultrasound and conventional ultrasound combined with contrast-enhanced ultrasound.Results:Of the 252 nodules,189 were benign and 63 were malignant.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of conventional ultrasound and contrast-enhanced ultrasound in the diagnosis of PCTN were 82.0%,88.9%,84.1%,95.7%,62.2%and 89.9%,85.7%,88.9%,94.9%,73.9%,respectively.The area under curve(AUC)was 0.854 and 0.878,respectively.After combined diagnosis,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 95.8%,84.1%,92.9%,94.8%and 86.9%,respectively,and the AUC was 0.899,which significantly higher than the single diagnostic method(P<0.05).Conclusion:Conventional ultrasound and contrast-enhanced ultrasound have high diagnostic efficacy for PCTN,and the combined application of the two can improve the diagnostic sensitivity,accuracy and negative predictive value,which is helpful to guide the treatment and management of PCTN.