超声引导下甲状腺细针穿刺联合常规超声在不同TI-RADS分级甲状腺结节中诊断价值分析

Analysis of diagnostic value of ultrasound-guided fine needle aspiration combined with conventional ultrasound in different TI-RADS grading thyroid nodules

目的探讨超声引导下甲状腺细针穿刺联合常规超声在不同甲状腺影像报告和数据系统(TI-RADS)分级甲状腺结节中诊断价值。方法选取2022年1月到2023年12月延安市人民医院收治的86例采取手术治疗的甲状腺结节患者(结节数96个)进行回顾性分析,分析患者术前超声诊断资料与超声引导下甲状腺细针穿刺诊断结果;以术后病理诊断作为“金标准”,建立受试者操作特征(ROC)曲线分析超声引导下甲状腺细针穿刺联合常规超声在不同TI-RADS分级甲状腺结节中诊断价值。结果86例甲状腺结节患者通过常规超声诊断,3类、4a类、4b类、4c类、5类结节数量分别为6个、46个、28个、11个、5个。常规超声3类良性结节占比为6.25%,低于手术病理结果(15.63%),4~5类恶性结节占比为93.75%,高于手术病理结果(84.37%),差异均有统计学意义(P<0.05)。86例甲状腺结节患者通过超声引导下甲状腺细针穿刺诊断3类良性结节占比12.50%,4~5类恶性结节占比87.50%,与手术病理结果(15.63%、84.37%)比较,差异均无统计学意义(P>0.05)。86例患者手术病理诊断确诊为恶性甲状腺结节的患者37例,良性58例。常规超声诊断准确率为65.12%,显著低于超声引导下甲状腺细针穿刺诊断准确率(94.19%)、手术病理诊断准确率(100.00%),差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,常规超声、超声引导下甲状腺细针穿刺、二者联合诊断甲状腺结节的敏感度从低到高依次为52.58%、80.25%、91.26%,特异度从低到高依次为64.32%、91.36%、98.63%。结论超声引导下甲状腺细针穿刺联合常规超声对甲状腺结节的鉴别与诊断具有显著价值,临床可考虑针对甲状腺结节患者通过常规超声进行TI-RADS分级,再针对4~5类患者采取超声引导下甲状腺细针穿刺进行诊断,提升诊断准确性。

Objective To explore the diagnostic value of ultrasound-guided fine needle aspiration combined with conventional ultrasound in different thyroid imaging reporting and data system(TI-RADS)grading thyroid nodules.Methods A retrospective analysis was conducted on 86 patients with thyroid nodules(96 nodules)who underwent surgical treatment in Yan'an People's Hospital from January 2022 to December 2023.Preoperative ultrasound diagnostic data and ultrasound-guided fine needle puncture diagnosis results were analyzed,with postoperative pathological diagnosis as the"gold standard",a receiver operating characteristic(ROC)curve was established to analyze the diagnostic value of ultrasound-guided fine needle aspiration combined with conventional ultrasound in different TI-RADS grading thyroid nodules.Results Eighty-six patients with thyroid nodules were diagnosed by conventional ultrasound,the number of nodules,in categories 3,4a,4b,4c,and 5 were 6,46,28,11,and 5,respectively.The proportion of benign nodules in category 3 of conventional ultrasound was 6.25%,which was lower than the surgical pathological results(15.63%),while the proportion of malignant nodules in category 4-5 was 93.75%,which was higher than the surgical pathological results(84.37%),and the differences were statistically significant(P<0.05).Eighty-six patients with thyroid nodules were diagnosed by ultrasound-guided fine needle aspiration of the thyroid gland.The proportion of benign nodules in category 3 was 12.50%,while the proportion of malignant nodules in categories 4-5 was 87.50%,compared with surgical pathological results(15.63%,84.37%),the differences were not statistically significant(P>0.05).Among 86 cases,37 cases were diagnosed as malignant thyroid nodules by surgical pathology,58 cases were benign.The accuracy of conventional ultrasound diagnosis was 65.12%,significantly lower than those of ultrasound-guided thyroid fine needle puncture diagnosis(94.19%)and surgical pathological diagnosis(100.00%),and the differences were statistically significant(P<0.05).The ROC curve analysis results showed that the sensitivity of conventional ultrasound,ultrasound-guided thyroid fine needle puncture,and their combined diagnosis of thyroid nodules was 52.58%,80.25%,and 91.26%,respectively,from low to high,and the specificity was 64.32%,91.36%,and 98.63%,respectively.Conclusion The combination of ultrasound-guided thyroid fine needle puncture and conventional ultrasound has significant value in distinguishing and diagnosing thyroid nodules.In clinical practice,TI-RADS grading can be considered for patients with thyroid nodules through conventional ultrasound,and ultrasound-guided thyroid fine needle puncture can be used for diagnosis of 4-5 types of patients to improve diagnostic accuracy.