超声造影联合细针抽吸活检对甲状腺良恶性结节的鉴别诊断价值  

Diagnostic value of contrast enhanced ultrasound combined with ultrasound-guided fine-needle aspiration in differentiating malignant and benign thyroid nodules

作　　者：孙永清[1] 刘利平[1] 史艳平 赵育芳[1] 王潇婧 魏玲玲 樊文文[1] Sun Yongqing; Liu Liping; Shi Yanping; Zhao Yufang; Wang Xiaojing(Department of Ultrasound, the First Hospital of Shanxi Medical University, Taiyuan 030001, China)

机构地区：[1]山西医科大学第一医院超声科,太原030001

出　　处：《中华超声影像学杂志》2018年第10期875-880,共6页Chinese Journal of Ultrasonography

基　　金：山西省回国留学人员科研资助项目（2014-073）;国家人社部留学回国人员科技活动择优资助项目（2016-366）

摘　　要：目的评价超声引导下细针抽吸（US-FNA）、超声造影（CEUS）及二者联合对甲状腺良恶性结节的鉴别诊断价值。方法收集经手术病理证实的145例甲状腺结节患者共161个结节术前US-FNA及CEUS资料，US-FNA以Bethesda System分类≥Ⅳ作为恶性诊断标准，CEUS以均匀低增强、不均匀低增强、早期低增强为恶性诊断标准。将结节依据最大径分为大结节组（最大径〉1．0cm）和小结节组（0．5cm〈最大径≤1．0cm），评价CEUS、US-FNA及两种方法联合对结节良恶性的鉴别诊断价值。结果在诊断大结节方面，CEUS、US-FNA及二者联合的敏感性分别为88．0％、81．3％、94．7%，特异性分别为88．5％、100％、88．5％。CEUS与USFNA的敏感性差异无统计学意义（P=0．301），两种方法联合的敏感性高于US—FNA，差异有统计学意义（P=0．004）。在诊断小结节方面，CEUS、US-FNA及二者联合的敏感性分别为52．4％、78．6％、92．9％，特异性分别为94．400、100％、94．4％。US-FNA的敏感性高于CEUS，两种方法联合的敏感性更高，差异均有统计学意义（P〈0．05）。结论对于最大径〉1．0cm的甲状腺结节，应用CEUS与US-FNA的敏感性无差异，两种方法联合的敏感性较US-FNA高；对于0．5cm％最大径≤1．0cm的结节，US-FNA的敏感性高于CEUS，两种方法联合的敏感性更高。Objective To evaluate the diagnostic value of contrast enhanced ultrasound （CEUS） combined with ultrasound-guided fine-needle aspiration （US-FNA） in differentiating malignant and benign thyroid nodules. Methods A retrospective review of preoperative CEUS and US-FNA data of 161 thyroid nodules confirmed by surgical pathology from 145 patients was performed. The CEUS enhancement patterns of whole phase hypo enhancement, uneven hypo-enhancement and early phase hypo-enhancement were taken as the diagnostic criteria for malignant thyroid nodules. According to the Bethesda System, the grade-IV was taken as the cytologic criteria for diagnosis of malignant thyroid masses. The 161 thyroid nodules were divided into large nodules group（the longest diameter of thyroid nodules were higher than 1.0 cm） and small nodules group （the longest diameter of nodules were higher than 0.5 cm but lower than 1.0 cm）. The diagnostic value of CEUS, US-FNA and the combination were evaluated respectively in the the two groups. Results In large nodules group, the sensitivities of CEUS, US-FNA and the combination were 88.0% , 81.3% , 94.7% , respectively ; their specificities were 88.5 %, 100% ,88.5% , respectively. There was no statistically difference in sensitivity between CEUS and US-FNA （ P = 0. 301）, the sensitivity of the combination was higher than US-FNA （ P = 0. 004）. In small nodules group, the sensitivities of CEUS, USFNA and the combination were 52.4 % , 78.6 % ,92.9 %, respectively ; their specificities were 94.4%, 100 %, 94.4%, respectively. There was statistically difference in sensitivity hetween CEUS and US-FNA （ P 〈0.05） ,the combination had the highest sensitivity （ P 〈0.05）. Conclusions For thyroid nodules whose longest diameter higher than 1 cm,there is no statistically difference in sensitivity between CEUS and US-FNA. The combination had higher sensitivity than US-FNA. For thyroid nodules whose longest diameter higher than 0.5 cm but lower than 1.0 cm, US-FNA provided higher sensitivi

关 键 词：超声造影 甲状腺结节 活组织检查 针吸 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学] R581[医药卫生—临床医学]