US-FNA联合CK-19、TPO检测对C-TIRADS 4A/4B分类甲状腺结节的诊断价值  

Diagnostic value of US-FNA combined with CK-19 and TPO for C-TIRADS 4A/4B thyroid nodules

作　　者：施权 邱国春 Shi Quan;Qiu Guo-chun(Department of Breast,Thyroid,and Vascular Surgery,The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China)

机构地区：[1]西南医科大学附属中医医院乳腺甲状腺血管外科,四川泸州646000

出　　处：《中国现代医学杂志》2023年第22期76-81,共6页China Journal of Modern Medicine

基　　金：四川省科技计划项目(No:2022YSFS0616)。

摘　　要：目的 探究超声引导下细针穿刺(US-FNA)联合细胞角蛋白(CK-19)、甲状腺过氧化物酶抗体(TPO)检测对C-TIRADS 4A/4B分类甲状腺结节的诊断价值。方法 选取2021年4月—2023年4月在西南医科大学附属中医医院治疗的98例甲状腺结节患者,共纳入123个结节,患者均接受术后病理检查,结节良恶性诊断明确。所有患者行US-FNA检查,采用免疫组织化学MaxiVision两步法检测CK-19、TPO表达。结果 98例(123个)结节中,术后病理检查诊断良性结节87个(70.73%),恶性36个(29.27%)。经US-FNA诊断,恶性结节以Ⅴ类为主,为52.78%(19/36),良性结节以Ⅱ类为主,为56.32%(49/87)。恶性结节的CK-19阳性表达率、TPO阴性表达率均高于良性结节(P <0.05)。以术后病理检查为金标准,123个结节经US-FNA检查漏诊13个,误诊3个;经CK-19检查,漏诊7个,误诊11个;经TPO检查,漏诊10个,误诊13个;联合诊断漏诊9个,误诊2个。US-FNA检查诊断甲状腺结节恶性的准确率为86.99%,敏感性为88.5%(95%CI:0.824,0.941),特异性为86.6%(95%CI:0.807,0.925);CK-19诊断甲状腺结节恶性的准确率为85.37%,敏感性为72.5%(95%CI:0.665,0.785),特异性为91.6%(95%CI:0.866,0.965);TPO诊断甲状腺结节恶性的准确率为81.30%,敏感性为66.7%(95%CI:0.585,0.749),特异性为88.1%(95%CI:0.823,0.939);联合诊断甲状腺结节恶性的准确率为91.06%,敏感性为75.0%(95%CI:0.677,0.823),特异性为97.7%(95%CI:0.937,0.997)。结论 US-FNA联合CK-19、TPO检测对C-TIRADS 4A/4B分类甲状腺结节的诊断价值较高,能显著提高其诊断的准确性和特异性,值得临床推广。Objective To explore the diagnostic value of ultrasound-guided fine needle aspiration(US-FNA)combined with levels of cytokeratin-19(CK-19)and thyroid peroxidase antibody(TPO)for thyroid nodules classified as 4A/4B via C-TIRADS.Methods Ninety-eight patients with thyroid nodules treated in our hospital from April 2021 to April 2023 were selected,and a total of 123 thyroid nodules were included for the study.All thyroid nodules were pathologically examined to determine the malignancy.All patients received US-FNA,and the expressions of CK-19 and TPO were detected via immunohistochemistry.Results Among 123 thyroid nodules from 98 cases,87(70.73%)were diagnosed as benign nodules according to the pathological findings.The other 36 thyroid nodules were diagnosed as malignant,accounting for about 29.27%.As indicated by US-FNA,the majority of malignant nodules were of class V,accounting for 52.78%(19/36).In contrast,the majority of benign nodules were of class II,accounting for 56.32%(49/87).The positive expression rates of CK-19 and TPO in malignant thyroid nodules were higher than those in benign thyroid nodules(P<0.05).With postoperative pathological results as the gold standard,13 of the 123 thyroid nodules were missed and 3 were misdiagnosed by US-FNA.In light of CK-19 positivity for diagnosing thyroid nodules,7 were missed and 11 were misdiagnosed.By TPO positivity,10 were missed and 13 were misdiagnosed.The combined detection of them led to 9 cases of missed diagnosis and 2 cases of misdiagnosis.The accuracy,sensitivity and specificity of US-FNA for diagnosing malignant thyroid nodules were 86.99%,88.5%(95%CI:0.824,0.941)and 86.6%(95%CI:0.807,0.925),those of CK-1985.37%,72.5%(95%CI:0.665,0.785)and 91.6%(95%CI:0.866,0.965),those of TPO 81.30%,66.7%(95%CI:0.585,0.749),and 88.1%(95%CI:0.823,0.939),and those of the combined detection 91.06%,75.0%(95%CI:0.677,0.823)and 97.7%(95%CI:0.937,0.997),respectively.Conclusions US-FNA combined with CK-19 and TPO detection exhibits a high diagnostic value for thyroid nodules classi

关 键 词：甲状腺结节 细针穿刺 和细胞角蛋白 甲状腺过氧化物酶抗体 C-TIRADS分类 诊断价值 

分 类 号：R436.1[医药卫生—临床医学]