超声弹性成像、TSH、P53联合诊断甲状腺TI-RADS 4类结节良恶性的价值

Value and clinical significance of combined diagnosis of TSH and P53 in ultrasonic elastography for diagnosis of thyroid TI-RADS 4 nodules

目的 探讨超声弹性成像、促甲状腺激素(thyroid-stimulating hormone, TSH)、P53蛋白表达水平联合诊断甲状腺影像报告和数据系统(thyroid imaging reporting and data system, TI-RADS)4类结节良恶性的价值、意义。方法 选取2020年11月—2022年11月郑州大学附属郑州中心医院甲状腺TI-RADS 4类结节者80例,行超声弹性成像检查,以病理活检作为金标准,对比不同诊断方式的诊断价值和不同性质结节患者弹性应变率(strain rate, SR)、血清TSH、P53水平,分析SR、血清TSH、P53水平联合检测甲状腺TI-RADS 4类结节良恶性价值。结果 病理结果为:阳性57例,阴性23例;超声弹性成像的诊断敏感性、准确性、阴性预测值均高于TI-RADS分类(P<0.05);恶性结节患者SR、血清TSH、P53水平高于良性结节患者(P<0.05);受试者工作特征(receiver operating characteristic, ROC)曲线结果,SR、TSH、P53联合诊断恶性结节曲线下面积是0.847,最佳敏感性、特异性依次是85.96%、91.30%(P<0.05)。结论 超声弹性成像可提高甲状腺TI-RADS 4类结节定性诊断价值,且SR、血清TSH、P53水平联合诊断可进一步增加诊断敏感性与诊断特异性,可为临床完善治疗方案提供可参考依据。

Objective To investigate the value and significance of combining ultrasound elastography,thyroid-stimulating hormone(TSH),and P53 protein expression levels in the diagnosis of thyroid imaging reporting and data system(TI-RADS)4 types of nodules.Methods A total of 80 patients with thyroid TI-RADS 4 nodules in the Zhengzhou Central Hospital Affliated to Zhengzhou University from November 2020 to November 2022 were selected for ultrasound elastography examination.Pathological biopsy was used as the gold standard.The diagnostic value of different diagnostic methods and the elastic strain rate(SR),serum TSH,and P53 levels in patients with nodules of different nature were compared.The combined detection of SR,serum TSH,and P53 levels was analyzed for the value of diagnosing thyroid TI-RADS 4 nodules as benign or malignant.Results The pathological results were:57 positive cases and 23 negative cases;the diagnostic sensitivity,accuracy,and negative predictive value of ultrasound elastography were higher than those of TI-RADS classification(P<0.05);the SR,serum TSH,and P53 levels were higher in patients with malignant nodules than in patients with benign nodules(P<0.05);The results of the receiver operating characteristic(ROC)curve for the combined diagnosis of malignant nodules with SR,TSH,and P53 showed an area under the curve(AUC)of 0.847,with optimal sensitivity and specificity of 85.96%and 91.30%,respectively(P<0.05).Conclusion Ultrasound elastography can improve the qualitative diagnostic value of thyroid TI-RADS class 4 nodules,and the combined diagnosis of SR,serum TSH and P53 levels can further increase the diagnostic sensitivity and diagnostic specificity,which can provide a reference basis for clinical improvement of treatment plans.