超声弹性成像结合免疫组织化学染色对甲状腺细针穿刺2～3级病变结节的再分析  

Reanalysis of grade 2-3 thyroid nodules diagnosed by fine needle aspiration cytology using ultrasound elastography and immunohistochemistry before operation

作　　者：李霞[1] 谢玉环[1] 丁尚伟[1] 张世豪[2] 赖瑾瑜 邝永培[1] 罗海波[1] 袁智帆 Li Xia;Xie Yuhuan;Ding Shangwei;Zhang Shihao;Lai Jinyu;Kuang Yongpei;Luo Haibo;Yuan Zhifan(Department of Ultrasound,Dongguan People's Hospital Affiliated to Southern Medical University,Dongguan 523059,China;Department of Pathology,Dongguan People's Hospital Affiliated to Southern Medical University,Dongguan 523059,China)

机构地区：[1]南方医科大学附属东莞人民医院超声科,523059 [2]南方医科大学附属东莞人民医院病理科,523059

出　　处：《中华普通外科学文献（电子版）》2019年第1期38-42,共5页Chinese Archives of General Surgery(Electronic Edition)

基　　金：东莞市医疗卫生一般项目(2016105101026)

摘　　要：目的探讨超声弹性成像结合免疫组织化学染色对超声引导下甲状腺细针穿刺细胞学(US-FNAC)结果为2～3级结节手术切除前进行分析的意义。方法回顾性分析2015年1月至2017年12月,甲状腺结节手术切除患者术前US-FNAC诊断结果,根据US-FNAC结果,对2～3级病变的结节应用超声弹性成像和免疫组织化学进行分析,并与术后组织病理结果进行对比,比较US-FNAC独立诊断与US-FNAC联合超声弹性成像和免疫组织化学对甲状腺2～3级结节良恶性判断的敏感度、特异度和准确性。结果 66例患者(70个结节)为2级病变,64例患者(64个结节)为3级病变。对2～3级甲状腺结节良恶性的判断,独立诊断与联合诊断的敏感度、特异度、阳性预测值、阴性预测值、诊断准确性分别为84.75%vs 91.53%(χ~2=1.297,P=0.255)、81.33%vs 92.00%(χ~2=3.692,P=0.055)、78.13%vs 90.00%(χ~2=3.228,P=0.072)、87.14%vs 93.24%(χ~2=1.525,P=0.217)、82.84%vs91.79%(χ~2=4.851,P=0.028),两者的诊断准确性差异有统计学意义。联合诊断与组织病理的一致性(Kappa=0.863,P<0.01)高于US-FNAC独立诊断(Kappa=0.711,P<0.01)。结论术前应用超声弹性成像和免疫组织化学分析能提高2～3级甲状腺结节病变的诊断准确性。Objective To investigate the combination of elastic imaging(EI)and immunohistochemistry(IHC)for thyroid nodules with ultrasound guided fine needle aspiration cytology(US-FNAC)as grade 2 or 3 lesions.Methods The thyroid nodules were punctured with fine needle.According to the results of US-FNAC diagnosis,EI and IHC were used to analyze the nodule of grade 2 and grade 3 lesions before operation,and the results were compared with the pathological results after operation.The sensitivity,specificity and accuracy of independent US-FNAC and combined US-FNAC+EI+IHC diagnosis for benign and malignant thyroid nodules were compared.Results Retrospective analysis of preoperative FNA diagnosis in patients undergoing thyroidectomy showed 66 patients(70 nodules)with grade 2 lesions and 64 patients(64 nodules)with grade 3 lesions.The comparison of the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of the diagnosis of benign and malignant thyroid nodules of grade 2 or 3 between US-FNAC and US-FNAC combined with EI and IHC were 84.75%vs 91.53%(χ^2=1.297,P=0.255),81.33%vs 92.00%(χ^2=3.692,P=0.055),78.13%vs 90.00%(χ^2=3.228,P=0.072),87.14%vs 93.24%(χ^2=1.525,P=0.217),82.84%vs 91.79%(χ^2=4.851,P=0.028),respectively.The difference of accuracy between independent and combined diagnosis was statistically significant.The consistency between combined diagnosis and histopathology(Kappa=0.863,P<0.01)was higher than that between US-FNAC independent diagnosis and histopathology(Kappa=0.711,P<0.01).Conclusion The accuracy of diagnosis of thyroid nodule of grade 2-3 can be improved by using EI and IHC analysis before operation.

关 键 词：甲状腺结节 活组织检查 针吸 弹性成像技术 免疫组织化学 

分 类 号：R445.1[医药卫生—影像医学与核医学] R653[医药卫生—诊断学]