C-TIRADS分类联合SWE对FNA细胞学不明确的甲状腺结节的诊断价值  

C-TIRADS Categories Combined with SWE for Thyroid Nodules with Indeterminate Fine Needle Aspiration Cytology

作　　者：张卫兵[1] 陈天奕 何贝丽 陈建[1] 刘华[1] 毛伦 戚庭月[3] Zhang Weibing;Chen Tianyi;He Beili;Chen Jian;Liu Hua;Mao Lun;Qi Tingyue(Department of Ultrasound,Jiangsu Provincial Corps Hospital,Chinese People’s Armed Police Forces,Yangzhou,Jiangsu 225003,China;Medical College of Nantong University,Nantong,Jiangsu 226000,China;Department of Ultrasound,Medical Imaging Center,Affiliated Hospital of Yangzhou University,Yangzhou,Jiangsu 225012,China)

机构地区：[1]武警江苏省总队医院超声科,江苏省扬州市225003 [2]南通大学医学院,江苏省南通市226000 [3]扬州大学附属医院医学影像中心超声科,江苏省扬州市225012

出　　处：《中国超声医学杂志》2022年第7期737-741,共5页Chinese Journal of Ultrasound in Medicine

基　　金：扬州市科技局重点研发基金项目(No.YZ2020099)。

摘　　要：目的 探讨2020年中国超声甲状腺影像报告和数据系统(C-TIRADS)联合剪切波弹性成像(SWE)在超声引导下细针穿刺抽吸(FNA)细胞学不明确的甲状腺结节中的诊断价值。方法 回顾性分析经手术病理证实的243例FNA细胞学不明确的甲状腺结节患者的临床资料、声像图特征、C-TIRADS分类及剪切波弹性成像图像,计算C-TIRADS分级、SWE最大杨氏模量Emax及二者联合的诊断效能。结果 以手术病理结果为金标准,绘制受试者工作特征曲线(ROC),C-TIRADS分级及SWE Emax ROC曲线下面积(AUC)分别为0.853(95%CI:0.795~0.912)、0.849(95%CI:0.799~0.898),诊断灵敏度、特异度、阴性预测值、阳性预测值、准确度分别为82.9%(141/170)、79.5%(58/73)、66.7%(58/87)、90.4%(141/156)、81.9%(199/243)和80.6%(137/170)、76.7%(56/73)、62.9%(56/89)、89.0%(137/154)、79.4%(193/243);二者联合诊断灵敏度、特异度、阴性预测值、阳性预测值、准确度分别为94.7%(161/170)、76.7%(56/73)、86.2%(56/65)、90.4%(161/178)、89.3%(217/243),诊断灵敏度、阴性预测值及准确度均提高(P<0.05)。结论 C-TIRADS分类及SWE对FNA细胞学不明确的甲状腺结节均有较高诊断效能,二者联合运用能提高诊断灵敏度、阴性预测值及准确度,有助于FNA细胞学不明确的甲状腺结节的鉴别诊断。Objective To compare the diagnostic efficacy of Chinese Thyroid Imaging Report and Data System(C-TIRADS) categories combined with shear wave elastography(SWE) for thyroid nodules with indeterminate fine needle aspiration cytology. Methods The clinical data, sonographic features, C-TIRADS grading and SWE images of 243 patients of surgical pathologically proven thyroid nodules with indeterminate FNA cytology were retrospectively analyzed. The diagnostic efficacy of C-TIRADS categories, the maximum Young’s modulus(Emax) of SWE and the combination of the two methods were calculated respectively. Results The receiver operating characteristic(ROC) curves were drawn with surgical pathology results as the gold standard. The area under the ROC curve(AUC) of C-TIRADS and Emax were 0.853(95%CI: 0.795-0.912) and 0.849(95%CI: 0.799-0.898), respectively. The diagnostic sensitivity, specificity, negative predict value(NPV), positive predict value(PPV) and accuracy were 82.9%(141/170), 79.5%(58/73), 66.7%(58/87), 90.4%(141/156), 81.9%(199/243) and 80.6%(137/170), 76.7%(56/73), 62.9%(56/89), 89.0%(137/154), 79.4%(193/243), respectively. The sensitivity, specificity, NPV, PPV and accuracy of the combination of the two methods were 94.7%(161/170), 76.7%(56/73), 86.2%(56/65), 90.4%(161/178) and 89.3%(217/243), respectively. The diagnostic sensitivity, NPV and accuracy were improved(P<0.05). Conclusions C-TIRADS categories and SWE had high diagnostic efficacy for thyroid nodules with indeterminate FNA cytology. The combination of the two methods could improve diagnostic sensitivity, NPV and accuracy, and could help to differentiate benign and malignant thyroid nodules with indeterminate FNA cytology.

关 键 词：甲状腺结节 剪切波弹性成像 中国超声甲状腺影像报告和数据系统 细针穿刺抽吸 

分 类 号：R581[医药卫生—内分泌] R445.1[医药卫生—内科学]