超声引导下细针穿刺与三种TIRADS联合对甲状腺结节良恶性的诊断价值比较  

Comparison of ultrasound-guided fine needle puncture and three TIRADS in the diagnosis of benign and malignant thyroid nodules

作　　者：毛倩仪 施倩[1] 夏伟[1] MAO Qian-yi;SHI Qian;XIA Wei(The Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China)

机构地区：[1]上海中医药大学附属第七人民医院,上海200137

出　　处：《中国临床医学影像杂志》2023年第10期696-700,共5页Journal of China Clinic Medical Imaging

基　　金：国家自然科学基金项目(81873178)。

摘　　要：目的:比较超声引导下甲状腺细针穿刺细胞学检查(US-FNAC)与三种TIRADS对甲状腺结节良恶性的诊断价值。方法:回顾性分析248个甲状腺结节,并以超声图像按照ACR TI-RADS、Kwak TI-RADS、C-TIRADS分类的方法加以分级,且将手术病理结果作为金标准,比较联合US-FNAC前后C-TIRADS与其他两种方法诊断效能情况。结果:手术后病理检查结果中良性结节113个,恶性甲状腺结节135个;US-FNAC诊断的特异性为77.88%(88/113),灵敏度为91.11%(123/135),准确度为85.08%(211/248);C-TIRADS分类越高,其诊断出的恶性率越高(P<0.05);ACR TI-RADS、Kwak TI-RADS及C-TIRADS最佳截断值各为TR5、4c、4c;与联合US-FNAC前比较,Kwak TI-RADS+US-FNAC、C-TIRADS+US-FNAC诊断的特异度均明显增加(P<0.05);C-TIRADS+US-FNAC诊断的灵敏度值(97.78%)明显高于ACR TI-RADS+US-FNAC、Kwak TI-RADS+US-FNAC(P<0.05)。结论:C-TIRADS分类评估甲状腺结节良恶性具有很高的诊断价值,与US-FNAC联合可提高对甲状腺结节良恶性的诊断效能,有利于术前临床手术治疗策略的制定,且具有良好的前景。Objective:To compare the value of US-FNAC and three TIRADS in the diagnosis of benign and malignant thyroid nodules.Methods:Two hundred and forty-eight thyroid nodule samples were retrospectively analyzed and classified by ultrasonic images according to ACR TI-RADS,Kwak TI-RADS and C-TIRADS,and the surgical pathological results were used as the gold standard to compare the diagnostic efficacy of C-TIRADS and other two methods before and after US-FNAC.Results:There were 113 benign nodules and 135 malignant nodules by pathological examination after operation.The specificity,sensitivity and accuracy of US-FNAC diagnosis were 77.88%(88/113),91.11%(123/135)and 85.08%(211/248)respectively.The higher the classification of C-TIRADS was,the higher the malignant rate was(P<0.05).The optimal truncation values of ACR TI-RADS,Kwak TI-RADS and C-TIRADS were TR5,4c and 4c,respectively.Compared with before combination of US-FNAC,the diagnostic specificity of Kwak TI-RADS+US-FNAC and C-TIRADS+US-FNAC were significantly increased(P<0.05).The diagnostic sensitivity of C-TIRADS+US-FNAC(97.78%)was significantly higher than that of ACR TI-RADS+USFNAC and Kwak TI-RADS+US-FNAC(P<0.05).Conclusion:C-TIRADS classification has a high diagnostic value in the assessment of benign and malignant thyroid nodules.The combination with US-FNAC can improve the diagnostic efficiency of benign and malignant thyroid nodules,which is conducive to the formulation of preoperative clinical surgical treatment strategies prospectively.

关 键 词：甲状腺结节 活组织检查 细针 超声检查 

分 类 号：R736.1[医药卫生—肿瘤] R445.1[医药卫生—临床医学]