超声对511个甲状腺结节的八个恶性征象的诊断价值  

Diagnostic value analysis of eight ultrasound malignant signs of 511 thyroid nodules

作　　者：林友国[1] 陈梅青 林霞蓉[1] Lin Youguo;Chen Mei-qing;Lin Xiarong(Ultrasound Diagnosis,Preventive Treatment of Disease in Traditional Chinese Medicine,the Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine,Fuzhou 350004,China)

机构地区：[1]福建中医药大学附属人民医院治未病科超声诊断室,福州350004

出　　处：《实用医技杂志》2020年第2期149-152,共4页Journal of Practical Medical Techniques

基　　金：福建省教育厅中青年教师教育科研项目(JAT170277)。

摘　　要：目的回顾性分析511个甲状腺结节的8个超声恶性征象声像图,探讨超声恶性征象对判断甲状腺结节性质的诊断价值。方法入组511个甲状腺结节,其中410个结节经穿刺活检或手术切除而获得病理诊断,101个结节经过长期(不少于5年)复查而判断其性质为良性结节。依据结节性质,逐个分析8个超声恶性征象(实性极低回声、成角征、微分叶、边缘模糊、纵径/横径>1、实质微钙化、后方回声衰减、声晕厚度不均或中断)的诊断准确性指标(敏感度、特异度、诊断效率、阳性预断值、诊断指数、漏诊率、误诊率)。采用χ^2检验两两比较构成比。构建受试者工作特征曲线(ROC)分析其诊断价值。结果实质微钙化的敏感度最高(76.5%),实质极低回声的敏感度最低(6.5%);实质极低回声和声晕厚度不均或中断的特异度最高(98.9%、93.6%);实性极低回声的阳性预断值最高(84.2%);8个恶性征象的诊断效率均>50%;8个恶性征象的诊断指数均>105%。8个恶性征象的真假阳性构成比差异有统计学意义(χ^2=18.07,P<0.01)。ROC曲线下面积为0.703。结论甲状腺结节的8个超声恶性征象均具有一定的诊断价值,不同恶性征象的诊断价值不同。推荐综合应用8个超声恶性征象的诊断价值,对甲状腺结节性质作出科学诊断。Objective To explore the diagnostic value of ultrasound malignant signs for judging the nature of thyroid nodules by retrospective analysis of 8 ultrasound malignant signs of 511 thyroid nodules.Methods Five hundreds and eleven thyroid nodules were enrolled,among which 410 nodules were examined by biopsy or surgical resection to obtain pathological diagnosis,and 101 nodules were judged to be benign nodules after long-term review(no less than 5 years).According to the nature of the nodules,one by one analysis of 8 kinds of malignant signs(extremely low echo,into angle symptom,differential leaf,edge blur,longitudinal diameter/width>1,the essence of microcalcification,rear echo attenuation,acoustic halo uneven thickness or interrupt)diagnostic accuracy index(degree of sensitivity,degrec of specificity,diagnostic efficiency,positive prognostic value,diagnostic index,the missed diagnosis and misdiagnosis rate).Chi-square test was used to test the pairwise constituent ratio.Receiver operating characteristic(ROC)curve was constructed to analyze its diagnostic value.Results The sensitivity of parenchymal microcalcification was the highest(76.5%)and the sensitivity of parenchymal extremely low echo was the lowest(6.5%).The specificity of parenchymal extremely low echo and uneven halo thickness or interruption was the highest(98.9%,93.6%).The positive prognosis value of parenchymal extremely low echo was the highest(84.2%).The diagnostic efficiency of the 8 malignant signs was more than 50%.The diagnostic indexes of 8 malignant signs were all greater than 105%.The difference of true or false positive constituent ratio of 8 malignant signs was statistically significant(χ^2=18.07,P<0.01).The area of ROC curve was 0.703.Conclusion All 8 ultrasonic malignant signs of thyroid nodules have certain diagnostic value.The diagnostic value of different malignant signs is different.It is recommended to make a scientific diagnosis of the nature of thyroid nodules by comprehensively applying different diagnostic values of 8 kinds of ul

关 键 词：超声检查 甲状腺结节 诊断价值 

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]