Pathological and Clinical Correlation European Union-Thyroid Imaging Reporting and Data System (EU-TIRADS) Classification of Thyroid Nodules in Two University Hospitals in Cotonou

Introduction: Since its creation in 2017 by the European community, the EU-TIRADS classification has enjoyed an excellent reputation in several countries around the world. Indeed, several studies conducted in these countries testify to the effectiveness of this tool for the management of nodular thyroid pathology. However, in Benin, the contribution of this classification has not yet been evaluated. It is therefore to overcome this inadequacy that we undertook this study. Objective: Participate in improving the diagnostic and therapeutic management of thyroid nodules at the CNHU HKM in Cotonou and at the CHUZ in Suru-Léré. Methods: This is a cross-sectional study with retrospective data collection spread over a period of 3 years 5 months, from January 2019 to May 2022 and carried out jointly in the Endocrinology Metabolism Nutrition and ORL-CCF departments of the CNHU HKM of Cotonou and in the ORL-CCF department of the CHUZ of Suru-Léré. The study population consisted of patients who consulted the University Clinic of Endocrinology Metabolism Nutrition, the University Clinic of ORL-CCF of the CNHU-HKM and the University Clinic of ORL-CCF of the CHUZ of Suru-Léré for thyroid nodule and who have had surgery. The study data was collected from patients hospitalization records using a survey form. Results: On ultrasound, according to the EU-TIRADS classification, 56.8% of nodules presented a low risk of malignancy (EU-TIRADS 3) compared to respectively 19.8%;23% and 2.5% of nodules with zero (EU-TIRADS 2), intermediate (EU-TIRADS 4) and high (EU-TIRADS 5) risk of malignancy. Regarding the performance of this classification, it is sensitive in 37.5% of cases and has a specificity of 78.5% with a PPV (Positive Predictive Value) and a NPV (Negative Predictive Value) respectively of 6.6 % and 91.6%. Furthermore, the bivariate correlations revealed that the size of the nodule was significantly associated with the malignancy of the nodule (p = 0.014) and the calculated value of the Yule’s Q coefficient (0.375) reflects a moderate intensity of the connection between the EU-TIRADS and histology. Conclusion: the EU-TIRADS classification, due to its excellent NPV, is of great interest for the management of thyroid nodules at the CNHU-HKM of Cotonou and at the CHUZ of Suru-Léré. In view of this, particular emphasis must be placed on its regular and rigorous use.

Clinical study of preoperative fT4/fT3 quotient and thyroid function test in distinguishing benign from malignant thyroid nodules

Objective:To analyze the clinical and pathological characteristics of thyroid nodules and to explore the related risk factors of malignant thyroid nodules.Methods: According to the criteria of inclusion and exclusion, a total of 283 patients with thyroid nodules during January 2015 and December 2017 were divided into benign group (benign nodule,n =172) and malignant group (malignant nodule,n = 111) based on postoperative histopathological results. The age, sex, serum thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb), thyroid stimulating hormone (TSH), free thyroxine (fT4), free three iodine thyroxine (fT3) and fT4/ fT3 ratio were subjected to univariate analysis, and the risk factors of malignant thyroid nodule were screened by multivariate logistic regression analysis.Results:Univariate analysis showed that age, TgAb, fT4 (P < 0.05) and fT4/ fT3 quotient (P < 0.01) were significantly different between the two groups. The fT4/fT3 quotient is a risk factor of malignant nodules. Multivariate logistic regression analysis indicated that the risk factors of malignant thyroid nodule were age (0R: 0.934,95% CI:0.911-0.957), TgAb(0R: 2.069,95% CI: 1.008-4.247) and fT4 (0R: 1.206,95% CI: 1.038-1.401).Conclusion: The fT4/fT3 quotient has important diagnostic value in differentiating benign and malignant thyroid nodules. When fT4 / fT3 > 3, it increases the risk of malignancy. The age, TgAb and fT4 are independent risk factors for malignant thyroid nodule, which is of great value in distinguishing benign from malignant thyroid nodules.

Differentiation of Benign and Malignant Solitary Pulmonary Nodule: Literature Review

The solitary pulmonary nodule (SPN) is frequently seen on chest radiographs and computed tomography (CT), usually the identification is accidental. The overall prevalence of malignancy is relatively low but identification of malignancy of nodule is of prime importance. There are different characters of nodules indicating malignancy, and also the exposure of person to risk factors increases the chances of malignancy of nodule. Chances of malignancy rise with increasing size, the irregular, lobulated border of the nodules is highly associated with higher probability of malignancy and nodules with pure ground grass appearance have higher probability of malignancy, irregularly marginated nodule displaying a corona radiata sign indicating neoplastic infiltration with distortion of neighbouring tissue is almost certainly a malignant nodule. Stippled, punctuate, and eccentric calcifications are suggestive of malignancy. There are 20% - 75% of chances of malignancy if nodule is appeared with ground-glass opacity. Malignant nodules have higher growth rate as compared with benign nodules, malignant nodules usually have doubling time (DT) of 30 - 400 days while DT of more than 450 days is sign of benignity whereas doubling time less than 30 days is usually acute infectious process. The presence of fat within nodule is sign of benignity. Increasing density of the nodule is suggestive of malignancy and requires shorter follow up. Besides the nodule evaluation the chances of malignancy can also be evaluated through the exposure of patient to risk factors like age, current and past smoking status and history of extra thoracic malignancy. The management depends upon various factors mainly three strategies are applied for management including careful observation of nodule, use of diagnostic techniques like CT FNA, PET, and broncoscopy and surgery.

Difference in microvascular structure between benign and malignant pulmonary nodules and its relationship with CT enhancement

Objective： To investigate the enhancement basis and the mechanisms of solitary pulmonary nodules （SPNs） by comparing the differences in microvascular structure between benign and malignant lesions. Methods： Dynamic contrast-enhanced CT scan was performed on 53 patients with SPNs （diameter〈3 cm, 38 peripheral lung cancers, 5 hamartomas, 10 inflammatory lesions） using a Siemens Plus S or a Marconi MX8000 multi slices spiral CT scanner. The time-attenuation curves were interpreted. The microvascular density （MVD） and the continuity of the microvessels＇ basemental membrane in the dissected specimens were observed with the ABC （avldin-biotin complex） immuno-histochemical method in all patients. Results ：The CT enhancement values of lung cancer （49.05± 16.08 HU） and inflammatory lesions （49.59±21.30 HU） were significantly higher than those of hamartoma （8.98±4.56 HU） t=7.48, P〈0.051 t=8.35, P〈0.05）. But the enhancement of lung cancer was similar to that of inflammatory lesions （t=0.76, P±0. 05）. The time attenuation curve of inflammatory lesions tended to increase faster and reached a higher peak compared to the lung cancer, and both of them maintained a high plateau after crossing. The hamartoma showed a slight increase in the time-attenuation curve and demonstrated a lowplateau curve. The MVD of SPNs was positively correlated with CT enhancement （r=0. 8051）. The microvascular counts of peripheral lung cancer （48.45±10. 09） and inflammatory lesions （49. 60±19. 94） were significantly higher than those of hamartoma （8.70±7. 30） （t=11. 64, P〈0.001, t=6. 09, P〈0. 001 ）, but no significant difference was found between lung cancer and inflammatory lesions （t= -0.26, P=0.799）. There was no difference in the continuity of basement membrane between nodules with anen haneement less than 30 HU and those with an enhancement higher than 30HU （X^2=3. 13, P〉0.05 ）. Conclusion： The microvascular counts mainly contribute to the enhancement value of SPNs. The basement membrane is not related to nodule enhancement, but it might influence the pattern of the time-attenuation curve.

Role of magnetic resonance imaging in the detection and characterization of solid pancreatic nodules: An update

Pancreatic ductal adenocarcinoma is the most common malignant tumor of the pancreas. The remaining pancreatic tumors are a diverse group of pancreatic neoplasms that comprises cystic pancreatic neoplasms, endocrine tumors and other uncommon pancreatic tumors. Due to the excellent soft tissue contrast resolution, magnetic resonance imaging(MRI) is frequently able to readily separate cystic from noncystic tumors. Cystic tumors are often easy to diagnose with MRI; however, noncystic non-adenocarcinoma tumors may show a wide spectrum of imaging features, which can potentially mimic ductal adenocarcinoma. MRI is a reliable technique for the characterization of pancreatic lesions. The implementation of novel motionresistant pulse sequences and respiratory gating techniques, as well as the recognized benefits of MR cholangiopancreatography, make MRI a very accurate examination for the evaluation of pancreatic masses. MRI has the distinctive ability of non-invasive assessment of the pancreatic ducts, pancreatic parenchyma, neighbouring soft tissues, and vascular network in one examination. MRI can identify different characteristics of various solid pancreatic lesions, potentially allowing the differentiation of adenocarcinoma from other benign and malignant entities. In this review we describe the MRI protocols and MRI characteristics of various solid pancreatic lesions. Recognition of these characteristics may establish the right diagnosis or at least narrow the differential diagnosis, thus avoiding unnecessary tests or procedures and permitting better management.

基于改进胶囊网络的肺结节良恶性分类

肺结节良恶性鉴别在肺癌早期诊断中具有重要价值,深度学习技术特别是卷积神经网络(CNN)已成为该领域核心方法。然而,当前方法在处理肺结节大小、形状、生长方向等特征之间的空间关系时尚显不足,易受无关特征和噪声干扰。胶囊网络在处理特征空间关系和噪声上具有独特优势,但原始胶囊网络因其初始为单层卷积结构,只能处理手写数字体等简单图像,因此,文中提出一种改进的胶囊网络架构来解决上述问题。文中改进主要是对原始胶囊网络模型的增强与扩展,融入了双路并行卷积结构和反卷积层。并行卷积结构强化了模型对复杂图像特征的捕获能力,反卷积层增强了模型的空间解析力,提升了图像局部细节的识别精度。结合两者,改进的胶囊网络在肺结节良恶性分类任务中展现出高效的特征捕获能力和对噪声的鲁棒性。实验结果表明,在LIDC⁃IDRI标准数据集上,文中提出模型的各项性能指标优于现有方法,精确率达到了95.70%,特异性达到了98.58%,同时AUC高达97.98%。

MRI多b值DWI定量参数诊断实性肺结节良恶性的价值研究

目的 探讨MRI多b值DWI定量参数对实性肺结节良恶性的诊断价值。方法 分析本院经手术、穿刺活检及随访证实80例实性肺结节的临床及MRI资料为研究对象,恶性肺结节50例,良性30例。80例患者均行MRI多b值DWI序列检查, b值选取300、600、900、 1200s/mm^(2)。计算不同b值肺结节的表观弥散系数(ADC)值及DWI图像上测量病灶/脊髓信号比值(LSR)、病灶/骨骼肌信号比值(LMR)。符合正态分布的计量资料,采用组间t检验比较良恶性实性肺结节DWI各参数的差异,对于统计学分析有差异的参数,采用ROC并计算出AUC,分析DWI各参数诊断实性肺结节良恶性的诊断效能,获取最佳b值和阈值。结果 b值选取300、600、900、1200s/mm^(2)时,恶性肺结节ADC值均低于良性肺结节,差异有统计学意义(P<0.05),ROC曲线的AUC分别为0.672、0.714、0.850、0.728。且b值取900s/mm^(2)时,ADC值的诊断效能最大,鉴别诊断肺结节良恶性病变的阈值为1.29×10^(3)mm^(2)/s。b值选取300、600、900s/mm^(2)时,恶性肺结节LSR高于良性肺结节,差异有统计学意义(P<0.05),b值选取1200s/mm^(2)时,恶性肺结节LSR与良性肺结节的参数差异无统计学意义(P>0.05),ROC曲线的AUC分别为0.721、0.948、0.737。当b值取600s/mm^(2)时,LSR的诊断效能最大,鉴别诊断肺结节良恶性病变的阈值为0.36。b值选取300、600、900、1200s/mm^(2)时,恶性肺结节LMR与良性肺结节各参数差异无统计学意义(P>0.05)。结论MRI多b值DWI定量参数鉴别实性肺结节良恶性有较高的价值,b值取600 s/mm^(2)时,LSR的诊断效能最大,其次b值取900s/mm^(2)时,ADC值的诊断效能最大。

基于超声纹理特征与基于超声造影的预测模型鉴别最大径≤2 cm乳腺良恶性结节的对比研究

目的比较基于二维超声纹理特征(2D-Ultrasomics)的预测模型与基于超声造影(CEUS)的预测模型鉴别最大径≤2 cm乳腺良恶性结节的诊断价值。方法选取我院经病理确诊的乳腺结节患者109例(共112个结节),依据病理结果分为良性组58个和恶性组54个,均行二维超声及彩色多普勒(2D-CDUS)、CEUS检查,比较两组超声检查结果的差异;基于二维超声图像提取2D-Ultrasomics,使用最小绝对收缩和选择算子(LASSO)进行特征筛选。采用多因素Logistic回归分别构建2D-CDUS模型、2D-CDUS结合CEUS(2D-CD+CEUS)模型、2D-CDUS结合2D-Ultrasomics(2DCDUS+Ultrasomics)模型,绘制受试者工作特征(ROC)曲线评估各模型鉴别最大径≤2 cm乳腺良恶性结节的诊断效能;采用Hosmer-Lemeshow拟合优度检验评估模型的拟合度;绘制临床决策曲线评估模型的临床适用性。结果两组结节2D-CDUS图像特征(内部回声、边界、血流、短径)和CEUS图像特征(增强方式、增强时相、造影边界、增强均匀性、增强病灶范围)比较差异均有统计学意义(均P<0.05)。共提取818个2D-Ultrasomics,经过LASSO筛选后保留6个关键特征。根据多因素Logistic回归分析结果,纳入边界、短径构建2D-CDUS模型,纳入边界、短径、造影边界构建2D-CD+CEUS模型,纳入短径、灰度游程长度矩阵、灰度依赖矩阵、灰度大小区矩阵构建2D-CDUS+Ultrasomics模型。ROC曲线分析显示,2D-CDUS+Ultrasomics模型鉴别最大径≤2 cm乳腺良恶性结节的曲线下面积(AUC)为0.917,高于2D-CD+CEUS模型、2D-CDUS模型的AUC(0.892、0.823),且2D-CD+CEUS模型的AUC高于2D-CDUS模型的AUC,差异均有统计学意义(均P<0.001)。Hosmer-Lemeshow拟合优度检验显示,2D-CDUS模型、2D-CD+CEUS模型和2D-CDUS+Ultrasomics模型均具有良好的拟合度(P=0.818、0.103、0.281)。临床决策曲线分析显示,2D-CDUS+Ultrasomics模型在0.20~0.39、0.43~0.78及0.88~0.91概率阈值范围内具有较高的临床获益。结论基于2D-Ultrasomics的预测模型较基于CEUS的预测模型能更准确地鉴别最大径≤2 cm乳腺良恶性结节,有助于临床早期准确诊断乳腺小结节和制定治疗决策。

Comparison of three mathematical prediction models in patients with a solitary pulmonary nodule

Background： Effective methods for managing patients with solitary pulmonary nodules（SPNs） depend critically on the predictive probability of malignancy.Methods： Between July 2009 and June 2011, data on gender, age, cancer history, tumor familial history, smoking status, tumor location, nodule size, spiculation, calcification, the tumor border, and the final pathological diagnosis were collected retrospectively from 154 surgical patients with an SPN measuring 3-30 mm. Each final diagnosis was compared with the probability calculated by three predicted models—the Mayo, VA, and Peking University（PU） models. The accuracy of each model was assessed using area under the receiver operating characteristics（ROC） and calibration curves.Results： The area under the ROC curve of the PU model [0.800; 95% confidence interval（CI）： 0.708-0.891] was higher than that of the Mayo model（0.753; 95% CI： 0.650-0.857） or VA model（0.728; 95% CI： 0.623-0.833）; however, this finding was not statistically significant. To varying degrees, calibration curves showed that all three models overestimated malignancy.Conclusions： The three predicted models have similar accuracy for prediction of SPN malignancy, although the accuracy is not sufficient. For Chinese patients, the PU model may has greater predictive power.Background： Here, we introduced our short experience on the application of a new CUSA Excel ultrasonic aspiration system, which was provided by Integra Lifesciences corporation, in skull base meningiomas resection.Methods： Ten patients with anterior, middle skull base and sphenoid ridge meningioma were operated using the CUSA Excel ultrasonic aspiration system at the Neurosurgery Department of Shanghai Huashan Hospital from August 2014 to October 2014. There were six male and four female patients, aged from 38 to 61 years old（the mean age was 48.5 years old）. Five cases with tumor located at anterior skull base, three cases with tumor on middle skull base, and two cases with tumor on sphenoid ridge.Results： All the patents received total resection of meningiomas with the help of this new tool, and the critical brain vessels and nerves were preserved during operations. All the patients recovered well after operation.Conclusions： This new CUSA Excel ultrasonic aspiration system has the advantage of preserving vital brain arteries and cranial nerves during skull base meningioma resection, which is very important for skull base tumor operations. This key step would ensure a well prognosis for patients. We hope the neurosurgeons would benefit from this kind of technique.Background： The purposes of this study were to explore the effects of high mobility group protein box 1（HMGB1） gene on the growth, proliferation, apoptosis, invasion, and metastasis of glioma cells, with an attempt to provide potential therapeutic targets for the treatment of glioma. Methods： The expressions of HMGB1 in glioma cells（U251, U-87 MG and LN-18） and one control cell line（SVG p12） were detected by real time PCR and Western blotting, respectively. Then, the effects of HMGB1 on the biological behaviors of glioma cells were detected： the expression of HMGB1 in human glioma cell lines U251 and U-87 MG were suppressed using RNAi technique, then the influences of HMGB1 on the viability, cycle, apoptosis, and invasion abilities of U251 and U-87 MG cells were analyzed using in a Transwell invasion chamber. Also, the effects of HMGB1 on the expressions of cyclin D1, Bax, Bcl-2, and MMP 9 were detected. Results： As shown by real-time PCR and Western blotting, the expression of HMGB1 significantly increased in glioma cells（U251, U-87 MG, and LN-18） in comparison with the control cell line（SVG p12）; the vitality, proliferation and invasive capabilities of U251 and U-87 MG cells in the HMGB1 siR NA-transfected group were significantly lower than those in the blank control group and negative control（NC） siR NA group（P〈0.05） but showed no significant difference between the blank control group and NC siR NA group. The percentage of apoptotic U251 and U-87 MG cells was significantly higher in the HMGB1 siR NA-transfected group than in the blank control group and NC siR NA group（P〈0.05） but was similar between the latter two groups. The HMGB1 siR NA-transfected group had significantly lower expression levels of Cyclin D1, Bcl-2, and MMP-9 protein in U251 and U-87 MG cells and significantly higher expression of Bax protein than in the blank control group and NC siR NA group（P〈0.05）; the expression profiles of cyclin D1, Bax, Bcl-2, and MMP 9 showed no significant change in both blank control group and NC siR NA group. Conclusions： HMGB1 gene may promote the proliferation and migration of glioma cells and suppress its effects of apoptosis. Inhibition of the expression of HMGB1 gene can suppress the proliferation and migration of glioma cells and promote their apoptosis. Our observations provided a new target for intervention and treatment of glioma.

超声AI、弹性应变率及TSH检测在甲状腺结节良恶性鉴别中的应用研究

目的探讨超声人工智能(AI)、弹性应变率及促甲状腺激素(TSH)检测在甲状腺结节良恶性鉴别中的应用价值。方法本研究为回顾性研究,选取2022年1月至2024年2月延安市人民医院收治的甲状腺结节患者168例为研究对象,根据临床病理学检查结果分为良性组(n=106)和恶性组(n=62)。两组患者均行超声AI、弹性应变率及TSH检测。记录患者的病理检查结果,并以此为金标准,计算超声AI诊断结果、弹性应变率诊断结果、TSH水平诊断结果诊断甲状腺结节良恶性的特异度、灵敏度、误诊率、漏诊率,比较两组患者的TSH水平,采用受试者操作特征(ROC)曲线分析不同检查方法及联合检查的诊断效能。结果168例甲状腺结节患者中,共有206个甲状腺结节;经病理组织检查,良性组中20例淋巴细胞性甲状腺炎,28例增生性结节,58例甲状腺腺瘤;恶性组中52例甲状腺乳头癌,9例滤泡状癌,1例未分化癌。超声AI的诊断结果与病理检查结果比较,其灵敏度为90.32%,特异度为80.19%,漏诊率为9.68%,误诊率为19.81%。弹性应变率诊断结果与病理检查结果比较,其灵敏度为87.10%,特异度为87.74%,漏诊率为12.90%,误诊率为12.26%。恶性组患者的TSH水平为(2.54±0.52)mIU/L,显著高于良性组[(1.34±0.45)mIU/L],差异有统计学意义(P<0.05)。TSH诊断结果与病理检查结果比较,其灵敏度为88.71%,特异度为89.62%,漏诊率为11.29%,误诊率为10.38%。超声AI、弹性应变率、TSH及其联合诊断甲状腺结节良恶性的曲线下面积(AUC)值为0.809、0.824、0.841、0.903。结论超声AI、弹性应变率及TSH水平检测对于甲状腺结节良恶性诊断的效能较高,其中联合检测的应用价值更高。

乳腺超声BI-RADS 4类在乳腺癌患者良恶性鉴别中的应用

目的:探讨乳腺超声BI-RADS 4类在乳腺癌患者良恶性鉴别中的应用价值。方法:回顾性分析2023年1月—10月在盐城市妇幼保健院治疗的50例乳腺影像报告和数据系统(BI-RADS)4类乳腺结节患者的临床资料,均实施乳腺超声检查,以病理检查结果为金标准,分析乳腺超声对乳腺结节良恶性的诊断效能,对比良恶性结节的超声征象。结果:病理结果显示,恶性14例,良性36例;乳腺超声检查显示,恶性15例,良性35例,乳腺超声检查的灵敏度为85.71%、特异度为91.67%、准确率为90.00%,Kappa值=0.849,与病理检查结果一致性良好;恶性结节与良性结节在年龄、单发或多发、内部回声、后方回声方面差异无统计学意义(P>0.05),但恶性结节直径大于良性结节,且形态、边缘、高回声声晕、微钙化、汇聚征、弹性评分、血流分布等与良性结节相比差异有统计学意义(P<0.05)。结论:乳腺超声BI-RADS 4类在乳腺良恶性鉴别中的应用效果显著,良恶性病灶具有不同的超声影像特征,能提高对乳腺癌的诊断效能。

MSCT在孤立性肺结节良恶性鉴别诊断中的应用价值分析

目的探究多层螺旋CT(MSCT)在孤立性肺结节良恶性鉴别诊断价值。方法选取河南科技大学附属许昌市中心医院2021年1月至2023年1月收入孤立性肺结节总计72例,所有患者入院后均接受常规CT及MSCT检查,并以病理检查结果作为诊断金标准,分析MSCT在孤立性肺结节诊断效能以及良性结节与恶性结节CT征象特征。结果72例孤立性结节患者经病理检查,结果显示良性结节51例(70.83%)、恶性结节21例(29.17%)。MSCT的诊断准确率、特异性(93.06%、94.12%),高于常规CT(79.17%、80.39%),差异有统计学意义(P<0.05);恶性结节中钙化(14.29%)低于良性结节(39.22%),恶性结节中分叶征、毛刺征、胸膜凹陷征(85.71%、76.19%、71.43%),高于良性结节(13.73%、15.69%、7.84%),差异有统计学意义(P<0.05),而良性结节与恶性结节在空泡征对比差异无统计学意义(P>0.05);恶性结节中常规CT、MSCT中定量参数增强峰值(PH)、孤立性肺结节与主动脉强化峰值的比值(S_(PH)/A_(PH))均高于良性结节,差异有统计学意义(P<0.05)。结论MSCT应用于孤立性肺结节良恶性鉴别诊断中具有较高准确性,同时良恶性结节CT征象上差异显著,为临床早期鉴别诊断提供合理依据,医师能依据诊断结果制定出合理治疗方案。

高分辨率CT用于肺部小结节良恶性鉴别诊断的效果分析

目的分析高分辨率CT对肺部小结节良恶性的鉴别诊断效果。方法选取2021年2月至2023年4月我院收治的肺部小结节患者96例,均予以常规CT及高分辨率CT检查,评估图像质量,以最终手术病理结果为依据,分别进行两种检查方法与手术病理结果的一致性分析,比较两种检查方式的诊断效能。结果高分辨率CT图像质量优良率显著高于常规CT(P<0.05)。96例患者经手术病理检查确诊为肺癌阳性70例,阴性26例;高分辨率CT与手术病理诊断结果的一致性较好(κ=0.906,P<0.001);常规CT与手术病理诊断结果的一致性一般(κ=0.729,P<0.001)。高分辨率CT的灵敏度、特异度、准确率分别为97.14%、92.31%、95.83%,显著高于常规CT的80.00%、50.00%、71.88%(P<0.05)。结论与常规CT相比,高分辨率CT在肺部小结节良恶性鉴别诊断中的图像质量更佳,诊断效能更好,值得临床应用。

C-TIRADS与ACR-TIRADS对甲状腺结节的诊断效能对比研究

目的 对比研究由中华医学会制定的中国甲状腺影像报告与数据系统(C-TIRADS)与美国放射学院制定的甲状腺影像报告与数据系统(ACR-TIRADS)对甲状腺结节的诊断效能。方法 回顾性分析经手术病理证实的511例(527个结节)甲状腺结节患者的超声图像,分别按照C-TIRADS、ACR-TIRADS标准进行分类。以病理结果作为金标准,计算各分类的恶性率,并与指南推荐恶性率进行对比;绘制受试者工作特征曲线(ROC曲线),计算曲线下面积(AUC)。根据约登指数确定分类的最佳截断值,根据最佳截断值评价两种TIRADS对甲状腺结节良恶性的敏感度、特异度、阳性预测值(PPV)和阴性预测值(NPV)。结果 病理结果显示,527个结节中,良性结节333个,其中结节性甲状腺肿311个,腺瘤12个,桥本甲状腺炎3个、亚急性甲状腺炎3个,单纯囊肿3个,肉芽肿结节1个;恶性结节194个,其中乳头状癌182个,滤泡癌8个,髓样癌2个,转移癌2个。以病理结果作为金标准,C-TIRADS 2、3、4A、4B、4C和5类的恶性率分别为0、1.97%、10.34%、46.58%、88.19%和91.67%;ACR-TIRADS 1、2、3、4和5类的恶性率分别为0、1.30%、3.73%、20.18%和83.42%。C-TIRADS各分类间恶性率对比,差异有统计学意义(P<0.05);ACR-TIRADS各分类间恶性率对比,差异有统计学意义(P<0.05)。除C-TIRADS 5类和ACR-TIRADS 3~5类恶性率高于指南推荐恶性率外,其余各分类实际恶性率低于指南推荐恶性率,或基本相符。C-TIRADS、ACR-TIRADS诊断甲状腺结节良恶性ROC曲线的AUC分别为0.865、0.864,AUC相当。C-TIRADS、ACR-TIRADS诊断甲状腺结节良恶性的最佳截断值分别为4B类、5类。C-TIRADS、ACR-TIRADS的敏感度、特异度、PPV、NPV分别为92.27%(179/194)、82.88%(276/333)、75.85%(179/236)、94.85%(276/291)和85.57%(166/194)、90.09%(300/333)、83.42%(166/199)、91.46%(300/328)。C-TIRADS的敏感度高于ACR-TIRADS,特异度低于ACR-TIRADS,差异有统计学意义(P<0.05);C-TIRADS的NPV略高于ACR-TIRADS,PPV略低于ACRTIRADS,差异均无统计学意义(P>0.05)。结论 C-TIRADS与ACR-TIRADS对甲状腺结节的良恶性鉴别诊断均具有较高的价值,诊断效能相当,但C-TIRADS较ACR-TIRADS更简便易行。

多模态超声联合评分法对乳腺结节良恶性的应用分析

目的探讨多模态超声联合评分法对乳腺结节良恶性的诊断价值。方法选取医院2022年1月-2023年1月收治的108例乳腺结节患者,全部患者均行多模态超声检测,即乳腺影像报告和数据系统(BI-RADS)、增强型血流显像(e-Flow)、超声弹性成像应变率比值(SP),建立联合评分(BeS),并行穿刺活检或手术病理检查,将穿刺活检或手术病理检查结果作为“金标准”,分析多模态超声联合评分法对乳腺结节良恶性的鉴别诊断价值。结果108例乳腺结节患者共检出116个结节,其中良性69个,恶性47个;恶性结节多模态超声BeS较良性结节高,差异有统计学意义(P<0.05);绘制ROC曲线发现,多模态超声BeS对乳腺结节良恶性鉴别诊断的AUC为0.945,当cut-off值取2.210分时,可获得最佳鉴别诊断价值;将多模态超声BeS≥2.210分判定为恶性,依据穿刺活检或手术病理检查“金标准”,多模态超声联合检测对乳腺结节良恶性的鉴别诊断的灵敏度为98.55%,特异度为95.74%,准确度为97.41%,且与穿刺活检或手术病理检查结果一致性极好(Kappa值=0.810)。结论多模态超声联合评分法对乳腺结节良恶性具有较高诊断价值,可提高乳腺癌检出率,值得推广应用。

肺癌七项自身抗体联合检测在肺结节良恶性鉴别诊断中的应用价值

目的探讨肺癌七项自身抗体检测在肺结节良恶性鉴别诊断中的临床价值。方法选取肺癌患者45例作为观察组,另选同期收治的良性肺结节患者45例作为对照组,所有患者均采集血液进行抑癌基因53(p53)、干细胞转录因子2(SOX2)、肿瘤睾丸抗原7(GAGE7)、蛋白基因产物9.5(PGP9.5)、人癌抗原(Cage)、黑色素瘤抗原A1(MAGEA1)、肿瘤抗原4-5(Gbu4-5)检测,比较2组各抗体间差异;并依据肺癌肿瘤分期分为Ⅰ~Ⅱ、Ⅲ~Ⅳ期患者,比较2组各抗体间水平差异;绘制ROC曲线,分析各抗体及联合检测鉴别诊断良恶性肺结节的临床价值。结果观察组p53、SOX2、GAGE7、PGP9.5、Cage、MAGEA1、Gbu4-5水平高于对照组,差异有统计学意义(P<0.05)。45例肺癌患者中Ⅰ~Ⅱ期29例,Ⅲ~Ⅳ期16例;Ⅲ~Ⅳ期患者p53、SOX2、GAGE7、PGP9.5、Cage、MAGEA1、Gbu4-5水平高于Ⅰ~Ⅱ期患者,差异有统计学意义(P<0.05)。绘制ROC曲线显示,联合肺癌七项自身抗体检测鉴别诊断肺结节良恶性价值更高。结论肺癌七项自身抗体检测在肺结节良恶性鉴别诊断中价值高,可提高诊断灵敏度及特异度,有助于后续针对性治疗工作的开展。

C-TIRADS分类联合剪切波弹性成像鉴别诊断不同大小甲状腺结节的临床价值

目的 探讨C-TIRADS分类联合剪切波弹性成像(SWE)鉴别诊断不同大小甲状腺结节良恶性的临床价值。方法 选取经病理确诊的甲状腺结节患者139例(共139个结节),根据结节大小分为最大径≤10 mm组(58个结节)和最大径>10 mm组(81个结节)。术前均行常规超声检查并进行C-TIRADS分类;SWE获得结节杨氏模量最大值(Emax)和平均值(Emean),比较两组SWE参数的差异。绘制受试者工作特征(ROC)曲线分析C-TIRADS分类、SWE定量参数单独及联合应用鉴别不同大小甲状腺结节良恶性的诊断效能。结果 C-TIRADS分类诊断最大径≤10 mm组结节良性19个,恶性39个;诊断最大径>10 mm组结节良性50个,恶性31个。最大径≤10 mm组、最大径>10 mm组中良性结节与恶性结节Emax、Emean比较,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,C-TIRADS分类联合Emax鉴别最大径≤10 mm结节良恶性的AUC为0.950,均大于二者单独应用(0.866、0.840),差异均有统计学意义(均P<0.05);C-TIRADS分类联合Emax鉴别最大径>10 mm结节良恶性的AUC为0.952,大于Emax(0.777),差异有统计学意义(P<0.05),但与C-TIRADS分类(0.932)比较差异无统计学意义。C-TIRADS 4A类结节中有5个经病理确诊为恶性,其中4个结节的Emax均大于截断值。结论 C-TIRADS分类联合SWE可提高对最大径≤10 mm甲状腺结节良恶性的鉴别诊断效能,SWE可优化C-TIRADS 4A类结节的诊断准确率。

细针穿刺病理检查鉴别甲状腺结节良恶性的价值及其穿刺标本质量的影响因素分析

目的:探讨超声引导下的细针穿刺病理检查对甲状腺结节良恶性的鉴别价值,并分析其穿刺标本质量的影响因素。方法:收集2017年01月至2021年12月于我院行甲状腺结节细针穿刺活检的577例患者临床资料,其中79例(100个结节)接受了甲状腺手术切除并获得组织学病理结果,以手术病理学结果为诊断金标准,分析超声引导下细针穿刺病理检查对甲状腺结节良恶性的鉴别价值,采用二元logistics回归系数分析其标本质量的影响因素。结果:细针穿刺活检恶性病变敏感性为98.48%,特异性为91.18%,准确性为96.00%。细针穿刺活检病理检查与组织学病理检查病理分型结果一致性显示,Kappa值为0.914(P<0.05)。与非优良组相比,优良组诊断敏感性、特异性、准确性更高(P<0.05)。与诊断优良组相比,非优良组>1 cm占比更少,存在钙化占比更多(P<0.05);优良组穿刺标本细胞数量更充足,细胞蜡块制备效果更佳。二元logistics回归系数分析显示,最大直径、钙化是细针穿刺标本质量的重要影响因素(P<0.05)。结论:超声引导下细针穿刺病理检查对甲状腺结节良恶性鉴别及病理分型均体现较高临床价值;高质量样本有助于提高细针穿刺诊断结节良恶性的特异性、敏感性和准确性,最大直径、钙化是穿刺标本质量的影响因素。

常规超声联合超声造影在不同大小乳腺结节诊断中的应用价值

背景超声(ultrasound,US)和超声造影(contrast-enhanced ultrasound,CEUS)是乳腺结节常用的诊断方法,US联合CEUS对不同大小的乳腺结节诊断效能不同,对<1.0 cm乳腺结节的诊断效能尚不清楚。目的分析US联合CEUS对不同大小乳腺结节的诊断效能。方法回顾性收集2021年1月—2022年12月在解放军总医院第一医学中心超声诊断科进行过乳腺US、CEUS检查并有明确良恶性病理结果的847例患者的临床资料和超声图像。按大小将结节分为3组:组1大小≤1.0 cm,组2大小1.0~2.0 cm,组3大小>2.0 cm。比较3组乳腺结节的CEUS特征以及US联合CEUS对乳腺结节的诊断效能。结果847例患者均为女性,年龄18~75岁,平均年龄45岁。所有病变的平均大小为1.9 cm,范围为0.3~13.9 cm。≤1.0 cm组194例(良性148例,恶性46例)、1.0~2.0 cm组358例(良性220例,恶性138例)、>2.0 cm组295例(良性135例,恶性160例)病变。恶性病变的CEUS特征表现为向心性增强、高增强、不均匀增强、边界不清晰、形态不规则、增强范围扩大和放射状增强。不同大小恶性乳腺病变的CEUS特征(增强均匀性、有无充盈缺损和消退时间)存在差异,US联合CEUS对3组乳腺结节的受试者工作特征曲线下面积分别为0.844、0.932、0.928,其中≤1 cm组的曲线下面积明显低于其他两组(P<0.05)。结论不同大小的乳腺病变超声造影特征不同。常规超声联合超声造影对不同大小的乳腺病变诊断效能存在差异,对>1.0 cm的病灶诊断效能较高。

DCE-MRI定量参数联合小视野弥散加权成像对甲状腺良恶性结节鉴别的价值

目的探讨动态对比增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)定量参数联合小视野弥散加权成像在甲状腺良恶性结节鉴别中的应用价值。材料与方法收集2022年1月至2023年10月于滨州医学院附属医院诊治并经手术病理证实为甲状腺结节的患者38例(52个结节),将其分为良性结节组和恶性结节组。术前患者均行3.0 T MRI扫描,包括常规MRI、小视野弥散加权成像(b值取0、800 s/mm^(2))和DCE-MRI检查,并测量其表观弥散系数(apparent diffusion coefficient,ADC)值和DCE-MRI定量参数,包括对比剂容积转运常数(volume transport constant,K^(trans))、速率常数(rate constant,K_(ep))、血管外细胞外间隙容积分数(extravascular extracellular volume fraction,V_(e))。对甲状腺良恶性结节组的ADC、K_(ep)、V_(e)、K^(trans)采用独立样本t检验分析,以P<0.05为差异有统计学意义,后将差异有统计学意义的变量进行逐步logistic回归模型分析,得到甲状腺良恶性结节的独立预测因素,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析ADC、K^(trans)独立诊断模型及ADC与K^(trans)联合诊断模型的诊断效能。结果良性结节组平均ADC值、K^(trans)值、K_(ep)值分别为(1.659±0.370)×10^(-3)mm^(2)/s、(0.427±0.214)min^(-1)、(0.966±0.225)min^(-1),恶性结节组平均ADC值、K^(trans)值、K_(ep)值分别为(1.182±0.195)×10^(-3)mm^(2)/s、(0.178±0.073)min^(-1)、(0.600±0.248)min^(-1)。良性结节组的ADC、K^(trans)、K_(ep)值均高于恶性结节组,差异均有统计学意义(P<0.001)。经过独立样本t检验及逐步logistic回归分析显示,ADC值和K^(trans)差异具有统计学意义(P<0.05),是鉴别甲状腺结节良恶性的独立预测因子。单独ADC值曲线下面积(area under the curve,AUC)为0.915、单独K^(trans)值AUC为0.827。ADC值与K^(trans)联合诊断模型AUC为0.973,较二者单独应用明显增高,联合诊断模型诊断效能最高。经DeLong检验,联合诊断模型与单独K^(trans)诊断差异存在统计学意义(P<0.05)。ADC值与K^(trans)联合诊断模型在鉴别甲状腺良恶性结节中敏感度为97.3%,较ADC、K^(trans)更高,特异度为84.6%,较ADC值更高。结论ADC值和K^(trans)是鉴别甲状腺良恶性结节的重要参数,两者联合诊断可提高临床诊断准确性,为术前诊断提供重要依据。