Ultrasound in Ti-Rads Classification of Thyroid Nodules at the Marie Curie Medical Clinic

Introduction: A thyroid nodule is a localized hypertrophy within the thyroid parenchyma. The aim of our study was to study the benefit of ultrasound in the Ti-rads classification of thyroid nodules. Methodology: This was a prospective study with a descriptive aim, with prospective collection, which took place over a period of 17 months at the “Marie Curie” medical clinic. The ultrasound machine used was a Voluson E8 from 2011 and the examinations were carried out by two radiologists and two experienced sonographers. The parameters studied were sociodemographic data;clinical data and ultrasound aspects of the Ti-rads classification in the management of nodules. Results: We collected 235 patients out of 738 patients referred to the service for a cervical ultrasound, i.e. a frequency of 31.84% of cases. There was a female predominance with 95.7% of cases and a sex ratio of 0.04. The average age of our patients was 50 years. We found on cervical ultrasound: Isthmo-lobar glandular hyperplasia in 99 patients, i.e. a frequency of 42.1%. The Ti-rads 3 classification was the most represented in 69.4% of cases. The benignity criterion represented 85.6% of cases in our patients and the malignancy criterion represented 14.4% of cases. Conclusion: The precise description of a thyroid nodule provided by ultrasound (Ti-rads) is essential in the management of nodules.

The Reliability of Ultrasound Diagnosis in Differentiating Malignant from Benign Thyroid Nodules Using TI-RADS Selection Followed by FNA

Context: Diagnostic imaging has increased the rate of thyroid nodules detection and improved utilization of fine-needle aspiration (FNA). Objective: This study aims to demonstrate the effects of the most reliable non-invasive technique on thyroid nodules. Methods: Between 2016 and 2020, 190 patients with 214 nodules visiting King Khalid University Hospital were randomly selected and retrospectively reviewed. Following the ACR TI-RADS recommendations for FNA and correlating cytology reports. Two expert radiologists with ultrasonographic imaging experience re-evaluated and reviewed the images. 88 nodules (41%) in 79 patients were excluded because the nodule size was smaller than the FNA recommended size. Results: Following the ACR TI-RADS for FNA recommended selection, 27 nodules (21.4%) out of the recommended 126 nodules were consistent with malignancy in cytology, with overall mean sensitivities, specificities, accuracies, precisions, and negative predictive values (NPV) of 96.4%, 40.7%, 48.7%, 28.4%, and 98.6% respectively. The nodules were subdivided into the TI-RADS 3, 4, and 5. Conclusion: In conclusion, ACR TI-RADS is feasible, reliable, and well structured, easily applicable in thyroid nodules reporting. ACR TI-RADS can eliminate many unnecessary FNAs, providing a decline in costs and complications. We recommend the ACR TI-RADS in our radiology department to eliminate reporting discrepancies and cut costs, thereby standardizing the reports, improving intra-user agreements, and improving overall patients’ health care.

Artificial intelligence in the diagnosis of thyroid cancer:Recent advances and future directions

The diagnosis and management of thyroid cancer is fraught with challenges despite the advent of innovative diagnostic,surgical,and chemotherapeutic modalities.Challenges like inaccuracy in prognostication,uncertainty in cytopathological diagnosis,trouble in differentiating follicular neoplasms,intra-observer and inter-observer variability on ultrasound imaging preclude personalised treatment in thyroid cancer.Artificial intelligence(AI)is bringing a paradigm shift to the healthcare,powered by quick advancement of the analytic techniques.Several recent studies have shown remarkable progress in thyroid cancer diagnostics based on AI-assisted algorithms.Application of AI techniques in thyroid ultrasonography and cytopathology have shown remarkable improvement in sensitivity and specificity over the traditional diagnostic modalities.AI has also been explored in the development of treatment algorithms for indeterminate nodules and for prognostication in the patients with thyroid cancer.The benefits of high repeatability and straightforward implementation of AI in the management of thyroid cancer suggest that it holds promise for clinical application.Limited clinical experience and lack of prospective validation studies remain the biggest drawbacks.Developing verified and trustworthy algorithms after extensive testing and validation using prospective,multi-centre trials is crucial for the future use of AI in the pipeline of precision medicine in the management of thyroid cancer.

Real Time Ultrasound Elastography for the Differentiation of Benign and Malignant Thyroid Nodules

The purpose of this study was to evaluate the predictive value of real-time ultrasound elastography (RUE) in differentiating benign from malignant thyroid nodules, with fine needle aspiration cytology analysis as the reference standard. A total of 78 consecutive patients with thyroid nodules who were selected for fine needle aspiration biopsies were examined in this prospective study. 78 nodules in these patients were examined by conventional ultrasound, and ultrasound elastography. The final diagnosis was obtained from cytological findings. Tissue stiffness on ultrasound elastography was scored from 1 (low stiffness over the entire nodule) to 5 (high stiffness over the entire nodule and surrounding tissue). On real-time ultrasound elastography, 47 of 62 benign nodules (76%) had a score of 1 or 2, whereas 15 of 16 malignant nodules had a score of 3 to 5, with sensitivity of 93.7%, specificity of 90%, a positive predictive value of 71%, and a negative predictive value of 98%. Real-time ultrasound elastography is a promising imaging technique that is useful in the differential diagnosis of thyroid cancer. Utilization of ultrasound elastography could reduce the rate of thyroid biopsies because of its high elasticity being highly associated with benign cytology.

Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma

BACKGROUND Cervical lymph node metastasis in papillary thyroid carcinoma(PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients; however, it is not accurate in determining lymph node metastasis.AIM To evaluate the value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in PTC.METHODS A total of 94 patients with PTC were recruited. According to pathological results,lymph nodes were divided into two groups: metastatic group(n = 50) and reactive group(n = 63). The routine ultrasound findings, contrast-enhanced ultrasound and elastography data were recorded and compared. Logistic regression was used to generate predictive probability distributions for the diagnosis of lymph node metastasis with different indicators. Receiver operating characteristic curve analysis was used to test the efficacy of contrast-enhanced ultrasound combined with elastography based on routine ultrasound in evaluating PTC cervical lymph node metastasis.RESULTS The ratio of long diameter/short diameter(L/S) ≤ 2, irregular marginal morphology, missing lymphatic portal, peripheral or mixed blood flow distribution, peak intensity(PI), non-uniform contrast distribution and elasticity score in the metastatic group were significantly higher than those in the reactive group(P < 0.05). L/S ratio, missing lymphatic portal, PI and elasticity score had a significant influence on the occurrence of PTC cervical lymph node metastasis(P< 0.05). Furthermore, the area under the curve(AUC) for lymph node metastasis diagnosed using the combination of PI ratio, elasticity score, missing lymphatic portal and LS was 0.936, which was significantly higher than the AUC for PI ratio alone. The difference was statistically significant(P < 0.05). The fitting equation for the combined diagnosis was logit(P) =-12.341 + 1.482 × L/S ratio + 3.529 ×missing lymphatic portal + 0.392 × PI + 3.288 × elasticity score.CONCLUSION Based on the gray-scale ultrasound, the combination of contrast-enhanced ultrasound and elastography can accurately assess PTC cervical lymph node metastasis.

Assessment of Malignancy Risk in Thyroid Nodules Using a Practical Ultrasound Predictor Model: “Alpha Score”

Objective: The aim of this study was to develop a simple predictor model to diagnose malignancy by using ultrasound features of thyroid nodules and the association with cytopathological diagnosis obtained by fine needle aspiration. Materials and Methods: The likelihood of malignancy from ultrasound features was assessed in thyroid nodules obtained by fine-needle aspiration biopsy (FNAB) according to cytopathological findings reported using Bethesda System. A score was developed depending on the presence of each ultrasound feature evaluated. Results: 429 nodules were assessed, 103 (24%) were malignant. The following ultrasound features were associated with malignancy, according to the logistic regression analysis and were assigned a score of 0, +1, +2 depending on the presence or absence of each one: hypoechogenicity, solid appearance, irregular margins, microcalcifications, absence of a halo, diameter of &ge;10 mm and intranodular vascular flow. The area under the curve of the proposed model was 0.900, demonstrating its predictive capacity. 4 risk categories were stablished based on the score obtained. Malignant nodules scored higher than the benign nodules (7.24 &plusmn;1.87 vs. 3.74 &plusmn;1.83). Conclusions: The proposed predictive model demonstrated to be useful and easy to apply when stratifying thyroid nodule risk of malignancy using presented US features and applying the proposed risk categories to increase the accuracy at selecting nodules that need to be studied with FNA.

The Diagnostic Value of Color Doppler Ultrasound and Grey Scale Sonography in Predicting the Malignancy of Thyroid Nodules

Retrospective study was done at KAUH to determine the sonographic characteristics in predicting the malignancy of thyroid nodules. The sample was 120 patients consisting of 70 benign nodules and 50 malignant nodules. Out of 120 patients, 106 (88.3%) female and 14 (11.7%) male patients. Out of 106 female patients, 64 (91.45) had benign and 42 had malignant thyroid nodules. Out of 14 (11.7) male patients, 6 had benign and 8 had malignant thyroid nodules. The youngest patient in our study was 31 years and the oldest patient was 76 years. The common range of patients age was ≥ 60 years and consisting of twenty (28.6%) benign thyroid nodules and fourteen (28%) malignant thyroid nodules. The majority of patients’ age group with malignant thyroid nodules were between 50 - 60 years and consisting of twenty (40%) malignant nodules. In our study, according to the result of gray scale and color Doppler ultrasonography, hypo-echogenicity, solid echo structure, micro-calcification and intra-nodular vascularity were the significant characteristics of malignancy in nodules with sensitivity (72%, 74%, 48% and 88% respectively), specificity (66%, 63%, 94% and 69% respectively), PPV (60%, 59%, 86% and 67% respectively) and NPV (77%, 77%, 72% and 89% respectively).

^(99m)TcO4-SPECT/CT甲状腺核素显像联合超声及TSH对甲状腺结节性质的诊断价值

目的通过高锝酸钠-单光子发射计算机断层显像/电子计算机X射线断层扫描技术(^(99m)TcO4-SPECT/CT)核素显像提供甲状腺结节功能状态、结节解剖特点以及超声检查联合血清促甲状腺激素(TSH)水平进一步鉴别诊断甲状腺结节的良恶性,客观评价甲状腺结节的良恶性情况,对甲状腺结节的良恶性做出早期诊断。方法对因甲状腺结节同时行^(99m)TcO4-SPECT/CT甲状腺核素显像、甲状腺B超及TSH水平检查的患者共80例(92个结节)进行回顾性分析,对比不同方法及联合检查对甲状腺结节的诊断效能。结果92个结节中良性74个,恶性18个;^(99m)TcO4-SPECT/CT甲状腺显像与超声检查比较灵敏度(77.8%)高,特异度(70.2%)及准确度(71.7%)低,假阳性率(29.7%)高,假阴性率(22.2%)低,两者之间灵敏度、特异度、准确度、假阳性率、假阴性率差异均具有统计学意义(P<0.05);两者准确度比较差异无统计学意义(P>0.05)。^(99)mTcO4-SPECT/CT甲状腺显像与超声检查比较灵敏度高,特异性及准确度低,假阳性率高,假阴性率低,两者之间灵敏度、特异度、准确度、假阳性率、假阴性率差异均具有统计学意义(P<0.05);两者准确度比较差异无统计学意义(P>0.05);^(99m)TcO4-SPECT/CT甲状腺显像与超声检查联合较单独核素、单独超声检查灵敏度(88.9%)、特异度(87.8%)、准确度(81.5%)高,假阳性率(12.1%)、假阴性率(11.1%)低;联合检查与单独核素特异度、准确度、假阳性率比较差异有统计学意义(P<0.05),灵敏度与假阴性率比较差异无统计学意义(P>0.05);联合检查与单独超声灵敏度、准确度、假阴性率比较差异有统计学意义(P<0.05);特异度与假阳性率比较差异无统计学意义(P>0.05)。结论超声可以作为甲状腺结节的首选检查方法,其特异性高,但灵敏度低。^(99m)TcO4-SPECT/CT甲状腺显像在提供功能和代谢信息的同时,能提供解剖信息;而血清TSH水平则可为甲状腺结节的良恶性鉴别提供重要的参考依据,尤其对于核素冷结节且超声实性结节的患者,更应参考其TSH水平,将三者结合起来判断甲状腺结节的性质,为临床提供恰当的治疗方案,这具有重要意义。

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

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。

融合多尺度特征和注意力机制的超声甲状腺结节分割

针对目前超声影像下甲状腺结节分割不够精准的问题,提出一种融合多尺度特征和注意力机制的超声甲状腺结节分割方法。该模型编码设计了多感受野通道选择模块,通过核心选择注意力对多个不同感受野的特征进行自适应加权组合,使包含目标的感受野通道占据主导。同时,设计自适应全局上下文模块自适应地提取瓶颈层多个尺度的全局上下文特征,以实现对瓶颈层高级语义的有效编码。此外,设计双注意力引导模块增强编解码器对等层之间的特征融合,以减少上采样过程中的信息损失。在公开的超声甲状腺结节数据集上进行实验,结果表明,文中所提方法优于其他对比网络,能更加精准地分割出甲状腺结节,有效提升了甲状腺结节的分割性能。

基于超声的影像组学在甲状腺结节诊断中的研究进展

近几年甲状腺结节的检出率显著提高,虽然公认甲状腺乳头状癌的侵袭性低,但仍有部分患者在术后复发或远处转移,2015年美国甲状腺协会指南中明确提出其主要目标是:减小对大多数与疾病相关的死亡、复发的风险,并降低对患者的过度治疗带来的潜在危害,而给予高危险患者恰当的治疗和监控。因此良恶性的鉴别诊断十分重要,但甲状腺结节良恶性之间存在重叠甚至完全相同,给常规超声诊断带来巨大的困难及挑战。甲状腺影像报告和数据系统分类国内外版本较多,不同医师之间使用一致性差异较大。目前超声引导下甲状腺结节穿刺活检术仍是术前诊断的金标准,但是仍有部分结节不能定性,尤其对于<1 cm结节也难以成功穿刺成功或取得准确的病理结果。BRAFV600E基因检测的特异度较高,但是敏感度较低。基于超声的影像组学是一门新兴的技术,它从超声图像中高通量提取和定量分析成像特征,可以获得肿瘤的形状、纹理和小波等特征,用机器学习方法来构建或预测模型客观地评估肿瘤良恶性与临床、病理、基因及蛋白质的关系,为临床医生提供有价值的信息。本文旨在综述多模态超声及基于超声的影像组学在甲状腺结节诊断中的研究进展。

基于临床与超声特征构建的列线图模型在超声医师修饰甲状腺中国(超声)甲状腺影像报告和数据系统分类结果中的应用价值

目的分析基于甲状腺临床与超声特征构建的列线图模型在超声医师修饰甲状腺中国(超声)甲状腺影像报告和数据系统(C-TI-RADS)分类结果中的应用价值。方法回顾性分析2021年1月—2022年12月四川省人民医院(训练集,n=841)以及四川绵阳四0四医院(外部验证集,n=295)外科手术切除的甲状腺结节患者的临床病理及超声资料,并利用术前甲状腺超声进行甲状腺结节C-TI-RADS分类。通过单因素及多因素Logistic回归分析在训练集中筛选独立预测因子并构建列线图模型,通过Bootstrap重抽样进行内部验证;四川绵阳四0四医院超声医师根据构建的列线图模型进行外部验证。绘制受试者工作特征(ROC)曲线及校准曲线,评估模型效能及在超声医师修饰C-TI-RADS分类结果中的临床价值。结果单因素及多因素Logistic回归分析结果显示,性别、年龄、结节最大径、结节数目、颈部淋巴结超声异常和C-TI-RADS分类是预测超声医师修饰C-TI-RADS分类结果的独立因素(P<0.05)。基于上述因素构建的列线图模型的一致性指数为0.842(95%CI:0.816~0.867),曲线下面积(AUC)为0.842,基于最佳截断值的敏感度为92.9%,特异度为63.7%,准确率为75.9%。在训练集和外部验证集中,构建的列线图模型的预测结果与实际情况均具有较好的一致性。结论基于甲状腺临床与超声特征构建的列线图模型在超声医师修饰C-TI-RADS分类结果中显示出良好的预测准确性,具有潜在的临床应用价值。

超声弹性评分联合血清甲状腺球蛋白水平对老年甲状腺癌患者治疗预后的预测价值

目的分析超声弹性评分与血清甲状腺球蛋白(Tg)水平联合预测老年甲状腺癌(TC)患者治疗预后的效用。方法选取76例老年TC患者,术前均行超声检查,并行超声弹性评分。于术后1年测定患者血清的Tg水平,分析不同临床病理特征的超声弹性评分与血清Tg水平;同时绘制受试者工作曲线(ROC),分析超声弹性评分、血清Tg水平单独与联合预测老年TC患者术后淋巴结转移的效能;另对比不同超声弹性评分与血清Tg水平患者无进展生存期。结果术后发生淋巴结转移患者术前超声弹性评分高于无淋巴结转移者,术后发生淋巴结转移患者术后1年的血清Tg水平高于无淋巴结转移者,有统计学差异(P<0.05)。ROC结果显示:超声弹性评分、血清Tg水平联合检测预测老年TC患者术后淋巴结转移的曲线下面积(AUC),高于两种方法单独检测。超声弹性评分<3.5分与血清Tg水平<24.995μg老年TC患者的无进展生存期高于超声弹性评分≥3.5分与血清Tg水平≥24.995μg的患者,有统计学差异(P<0.05)。结论超声弹性评分联合血清Tg水平可预测老年TC患者治疗预后。

基于超声造影特征构建列线图预测甲状腺微小乳头状癌颈淋巴结转移风险

目的通过分析甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)患者临床资料、结节超声和超声造影(contrast-enhanced ultrasound,CEUS)特征建立预测颈淋巴结转移(lymph node metastasis,LNM)风险的列线图模型,为合理规范的临床决策提供依据。方法回顾性分析2020年12月1日至2021年12月31日在新疆医科大学第一附属医院行甲状腺手术治疗的PTMC患者404个结节临床资料,应用随机函数按照7∶3分为建模组(n=282)与验证组(n=122)。应用Logistic回归分析筛选PTMC颈淋巴结转移的独立相关因素,构建列线图,以曲线下面积(area under curve,AUC)评估模型诊断效能,应用验证组数据进行外部验证。结果构建模型显示结节边缘、声晕、多灶性、包膜下生长或侵犯包膜、消退模式是颈淋巴结转移的危险因素(P<0.05);建模组AUC为0.747(0.690~0.804),最佳cut-off值为0.430,灵敏度0.65,特异度0.73;验证组AUC为0.778(0.697~0.860),最佳cut-off值为0.419,灵敏度0.64,特异度0.81。结论本研究构建的列线图可个体化预测PTMC颈淋巴结转移的风险,超声和超声造影特征有助于指导高风险人群的临床决策。

奇异值分解滤波在甲状腺结节微波消融围术期超声造影评估中的应用

目的:探讨奇异值分解(SVD)在优化超声造影(CEUS)图像质量以及甲状腺结节微波消融(MWA)围术期CEUS评估中的应用价值。方法:收集2023年4月在武汉科技大学附属华润武钢总医院2例行甲状腺结节MWA患者其围术期的二维超声、CEUS图像数据集,根据归一化互相关算法获取基于CEUS图像进行SVD滤波处理后的造影图像,比较原始CEUS图像和SVD滤波处理后的造影图像的信噪比(SNR)及微血管密度(MVD)的差异。结果:与甲状腺结节MWA术前和术后的原始CEUS图像相比,经SVD滤波处理后的造影图像能够更清晰显示结节内血管结构且检测出更多的血流信号。术后原始CEUS图像的平均SNR为(1.07±0.66)dB,术后经SVD滤波处理后的造影图像平均SNR为(6.21±1.01)dB(t=-6.015,P=0.038)。术后原始CEUS图像的平均MVD为(0.60±0.33)%,术后经SVD滤波处理后的造影图像平均MVD为(5.42±0.67)%(t=-9.076,P=0.029)。术后经SVD滤波处理后的造影图像SNR、MVD,显著高于术后原始CEUS图像的SNR、MVD,其研究结果均具有统计学意义。结论:SVD滤波可有效抑制噪声并增强微血流信号,通过提升造影图像质量以用于甲状腺结节MWA围术期的精准诊断,灵敏地检测出术后残留的消融不完全区域,以指导临床医师进行更彻底地消融治疗,为精准消融疗效评估提供决策支持。

经颈超声检查评估咽喉部手术患者声带运动异常的价值

目的探讨经颈超声检查评估咽喉部手术患者声带运动异常的应用价值。方法选取2021年1月至2023年12月在海南省人民医院行甲状腺或咽喉部手术的49例患者纳入研究,所有患者术前及甲状腺患者术后均行喉镜及颈部超声检查声带运动情况,以喉镜评估声带运动为金标准,比较经颈超声与喉镜检查在评估声带运动方面有无差异。结果49例患者中行甲状腺肿瘤手术34例,术前超声检查显示声带区28例,超声与喉镜检查声带运动均正常。术后喉镜及超声检查均发现2例患者一侧声带固定,另喉镜提示1例患者一侧声带运动减弱,超声检查无阳性发现。喉部手术患者15例,均为喉癌;超声显示声带区结构的12例患者术前喉镜提示9例一侧声带固定,超声均正确诊断;另超声提示2例气道狭窄,声带运动减弱,因气道狭窄喉镜检查无法窥探至声带平面。将40例超声及喉镜均可显示声带区患者的声带运动情况进行比较,两者具有高度的一致性(Kappa值=0.826,P<0.001)。结论经颈超声检查作为一种非侵入式检查手段对部分患者声带运动情况的评估结果与喉镜检查结果具有高度的一致性,且简便易行,患者无需特殊准备,检查过程无痛苦,具有临床应用价值。

高频超声结合CT可有效诊断早期甲状腺乳头癌及颈部淋巴结转移

目的 探讨高频超声结合CT在早期诊断甲状腺乳头癌中的应用及对颈部淋巴结转移的预测价值。方法 回顾性分析2022年1月~2023年7月新疆医科大学第四附属医院收治的120例疑似甲状腺乳头癌患者的临床资料。所选患者均行甲状腺切除术及颈部淋巴结清扫,并进行高频超声及CT检查。以病理结果为金标准,统计高频超声、CT单独及联合检查检出甲状腺乳头癌及颈部淋巴结转移的情况,分析高频超声、CT单独及联合检查对甲状腺乳头癌的诊断价值和对颈部淋巴结转移的预测价值。结果 120例疑似甲状腺乳头癌患者中甲状腺乳头癌阳性107例(89.17%),阴性13例(10.83%);颈部淋巴结转移65例(54.17%),未转移55例(45.83%)。高频超声检出甲状腺乳头癌真阳性72例,真阴性9例;CT检出真阳性74例,真阴性10例;联合检查检出真阳性89例,真阴性11例。高频超声检出颈部淋巴结转移真阳性49例,真阴性43例;CT检出真阳性51例,真阴性44例;联合检查检出真阳性61例,真阴性52例。ROC分析结果显示,高频超声、CT联合检查诊断甲状腺乳头癌的敏感度、准确度、曲线下面积均高于高频超声、CT单独检查(P<0.05);高频超声、CT联合检查预测颈部淋巴结转移的敏感度、特异度、阳性预测值、阴性预测值、准确度、曲线下面积均高于高频超声、CT单独检查(P<0.05)。结论 高频超声结合CT早期诊断甲状腺乳头癌的价值较高,且可预测患者颈部淋巴结转移,二者联合检查的效果优于单独检查。

细针穿刺、粗针穿刺及两者联合诊断甲状腺结节的前瞻性对比研究

目的:对比研究超声引导下细针穿刺(FNA)、粗针穿刺(CNB)和粗细针穿刺结合(FNA+CNB)对同一甲状腺结节的诊断效能。方法:选取105例甲状腺结节患者(112个结节)作为研究对象,对每个结节同时行超声引导下细针(FNA)和粗针(CNB)穿刺,分别比较FNA、CNB、FNA+CNB对甲状腺结节的诊断效能;根据超声特征(结节最大径、粗大钙化、纵横比、囊实性)进行分组,比较FNA、CNB的诊断准确度。结果:剔除14个穿刺失败结节后,剩余98个结节进入研究,FNA、CNB取材成功率分别为89.4%、97.3%(P<0.05)。FNA、CNB、FNA+CNB诊断甲状腺结节的敏感度分别为93.1%、75.9%、100%,FNA、FNA+CNB优于CNB(P<0.05);特异度分别为60%、90%、57.5%,CNB优于FNA、FNA+CNB(P<0.05);阴性预测值分别为85.7%、72%、100%,FNA+CNB优于CNB(P<0.05)。ROC曲线分析显示,CNB曲线下面积(AUC)大于FNA(0.829 vs.0.766,P<0.05)。亚组分析中,对于直径<0.5 cm的结节,CNB诊断特异度高于FNA(100%vs.50%,P=0.014),FNA诊断敏感度高于CNB(93.3%vs.46.7%,P=0.033)。结节大小和纵横比可能会影响CNB的诊断结果,直径≥0.5 cm敏感度更高,纵横比≤1准确度更高(P<0.05);结节囊实性可能会影响FNA诊断结果,实性结节准确度更高(P<0.05)。结论:CNB对甲状腺结节良恶性的检出具有更高的诊断价值,但直径<0.5cm的结节使用FNA具有更高的敏感度。

疏肝消瘿方联合穴位敷贴治疗甲状腺结节的临床观察

目的:探讨疏肝消瘿方联合穴位敷贴治疗甲状腺结节的效果及对甲状腺激素、血流阻力指数(RI)、搏动指数(PI)、微血管密度(MVD)影响。方法:选取2022年1月至2023年6月上海交通大学医学院附属第六人民医院收治的甲状腺结节患者80例作为研究对象,按照随机数字表法随机分为对照组与观察组,每组40例。对照组患者给予西医治疗,观察组在对照组基础上,采用疏肝消瘿方联合穴位敷贴治疗。比较2组治疗效果,包括游离三碘甲状腺素(FT3)、游离甲状腺素(FT4)及促甲状腺激素水平(TSH),以及超声指标(RI、PI、MVD)的变化情况。结果:观察组患者治疗有效率为92.50%,显著高于对照组的75.00%(P<0.05),其中医证候积分也明显低于对照组(P<0.05);2组患者治疗前后,FT3和FT4水平差异无统计学意义(P>0.05),TSH水平比治疗前下降,且观察组治疗后TSH水平降低更多(P<0.05);治疗后2组患者RI、PI、MVD值明显低于治疗前(P<0.05),且观察组RI、PI、MVD明显低于对照组(P<0.05)。结论:疏肝消瘿方联合穴位敷贴可以改善甲状腺结节患者中医证候积分,降低TSH表达水平,减少RI、PI、MVD值,效果明显。

多普勒高频超声特征诊断超声造影表现为无增强的甲状腺结节良恶性的差异对比

目的探讨多普勒高频超声特征诊断超声造影表现为无增强的甲状腺结节良恶性的差异。方法选取2020年10月至2021年11月武城县中医院收治的46例超声造影表现为无增强的甲状腺结节患者作为研究对象,所有患者均接受病理诊断,根据病理诊断结果将结节分为良性组与恶性组,比较两组高频超声特征,包括毛刺、回声、钙化、血流分级情况及阻力指数(RI)、动脉血流收缩期峰值流速(SPV)。结果经病理检查结果显示,46例患者中共检出82个甲状腺结节,其中良性甲状腺结节37个,恶性甲状腺结节45个。恶性组结节存在毛刺、低回声、微小钙化、血流分级Ⅱ级所占的比例均高于良性组,差异有统计学意义(P<0.05)。两组RI、SPV比较差异无统计学意义。结论多普勒高频超声检查在鉴别良恶性甲状腺结节中具有良好的诊断效能,恶性结节多见有毛刺、低回声、微小钙化现象,且血流分级主要为Ⅱ级。