细针穿刺与对比增强超声对TI-R A DS 4类甲状腺结节诊断价值的比较  

Diagnostic value for the fine needle aspiration biopsy and contrast-enhanced ultrasound in thyroid imaging reported and data system Grade 4 nodules

作　　者：廖丽燕 易文君[2] 汪洋[1] 袁丽琴[2] LIAO Liyan;YI Wenjun;WANG Yang;YUAN Liqin(Department of Pathology,Second Xiangya Hospital,Central South University,Changsha 410011,China;Department of General Surgery,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院病理科,长沙410011 [2]中南大学湘雅二医院普外科,长沙410011

出　　处：《中南大学学报（医学版）》2019年第9期1071-1077,共7页Journal of Central South University ：Medical Science

摘　　要：目的:评价超声引导下细针穿刺活检(ultrasound-guided fine needle aspiration biopsy,US-FNAB)和对比增强超声(contrast-enhanced ultrasound,CEU)对甲状腺影像报告和数据系统(thyroid imaging reported and data system,TI-RADS)4类甲状腺结节的诊断价值。方法:回顾性分析已行手术治疗的甲状腺结节、其术前常规彩色B超检查结果为TI-RADS4类的患者134例,并收集US-FNAB,CEU和术后病理切片结果的资料。以手术后组织病理结果为金标准,对US-FNAB标本行HE染色和细胞学检查。计算CEU和US-FNAB的灵敏度、特异度、准确率及费用。比较CEU与US-FNAB的诊断价值。结果:134例甲状腺结节中,有恶性结节131例,良性结节3例。US-FNAB和CEU的灵敏度分别为87.02%和93.89%,特异度分别为100.00%和66.67%,准确率分别为87.31%和93.28%。配对χ^2检验显示:CEU和US-FNAB的灵敏度差异无统计学意义(P>0.05);但在结节直径≤10 mm的患者中,US-FNAB和CEU的灵敏度分别为87.50%和100.00%,差异有统计学意义(P<0.05);结节直径>10 mm的患者中,US-FNAB和CEU的灵敏度分别为92.73%和85.45%,差异无统计学意义(P>0.05)。US-FNAB费用及风险均高于CEU。结论:对于直径>10 mm的甲状腺结节,US-FNAB检查的敏感度高于CEU,而对于US-FNAB诊断为阴性、直径≤10 mm的甲状腺结节,仍可推荐检出率高、安全、经济的CEU检查。Objective:To study the clinical application value of ultrasound-guided fine needle aspiration biopsy (US-FNAB) and contrast-enhanced ultrasound (CEU) in the diagnosis of thyroid imaging reported and data system Grade 4 (TI-RADS 4) nodules. Methods:A retrospective analysis of 134 patients with thyroid nodules surgery were selected,and their results of preoperative color Doppler ultrasonography were TI-RADS 4.The data of US-FNAB and CEU before operation and the results of pathological section after operation were collected. The pathological results were taken as the gold standard,and the specimens obtained by US-FNAB puncture were used for HE staining and cytological diagnosis.The sensitivity,specificity,accuracy and the cost were calculated for CEU and US-FNAB,respectively.The diagnostic efficacy of the 2 methods was compared. Results:Of 134 thyroid nodules,there were 131 malignant nodules (97.76%) and 3 benign ones (2.24%).The sensitivity of US-FNAB and CEU were 87.02% and 93.89% respectively.The specificity of US-FNAB and CEU were 100.00% and 66.67%.The accuracy of US-FNAB and CEU were 87.31% and 93.28% respectively.Comparisons of the diagnostic accuracy were performed by χ^2 test.There was no significant difference in sensitivity between CEU and US-FNAB (P>0.05). However,the sensitivity of US-FNAB and CEU were 87.50% and 100.00%,respectively,when the maximum diameter of nodule was less than 10 mm,and there was statistical significance (P<0.05). The sensitivity of US-FNAB and CEU were 92.73% and 85.45%,respectively,when the maximum diameter of nodule was more than 10 mm,and there was no statistical significance (P>0.05).The cost and risk of US-FNAB was higher than those of CEU. Conclusion:The sensitivity of US-FNAB is higher than that of CEU for thyroid nodules with the diameter larger than 10 mm.With high detection rate,good safety and low cost,CEU can still be used for thyroid nodules with the diameter less than 10 mm,which is diagnosed as negative nodules by US-FNAB.

关 键 词：甲状腺结节 细针穿刺活检 对比增强超声 

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