多模态超声联合细针抽吸活组织检查对直径≤5 mm甲状腺微小癌诊断分析  

Diagnosis and Analysis of Multimodal Ultrasound Combined with Fine Needle Aspiration in the Diagnosis of Thyroid Microcarcinoma≤5 mm in Diameter

作　　者：花霞[1] 鹿丹丹 梁燕 赵艳红 HUA Xia;LU Dandan;LIANG Yan;ZHAO Yanhong(Department of Ultrasound Medicine,the First Hospital of Handan City,Handan,Hebei 056002,China)

机构地区：[1]邯郸市第一医院超声医学科,河北邯郸056002

出　　处：《临床误诊误治》2024年第9期25-29,共5页Clinical Misdiagnosis & Mistherapy

基　　金：河北省2021年度医学科学研究课题计划(20211043)。

摘　　要：目的 分析多模态超声联合细针抽吸活组织检查(fine needle aspiration, FNA)对直径≤5 mm甲状腺微小癌(thyroid microcarcinoma, TMC)的诊断准确性。方法 回顾性分析2019年9月-2021年3月行多模态超声(二维超声、超声造影、超声弹性成像)联合FNA检查,且经手术病理证实为直径≤5 mm甲状腺微小结节120例(结节132个)的临床资料,分析多模态超声和FNA及联合检测与病理诊断结果的一致性,并采用受试者工作特征(ROC)曲线分析单项和联合检测的诊断价值。结果 132个直径≤5 mm甲状腺微小结节经术后病理结果分析,良性结节36个,TMC 96个。与病理结果比较,二维超声诊断符合率为85.60%(113/132),Kappa值0.646;超声造影诊断符合率为90.15%(119/132),Kappa值0.758;超声弹性成像诊断符合率为90.15%(119/132),Kappa值0.754;多模态超声诊断符合率为90.91%(120/132),Kappa值0.771;FNA诊断符合率为92.42%(122/132),Kappa值0.806;多模态超声联合FNA诊断符合率为94.70%(125/132),Kappa值0.860。ROC曲线分析结果显示,多模态超声与FNA单项诊断曲线下面积比较无差异(P>0.05);多模态超声与FNA联合诊断TMC的曲线下面积大于单项诊断(P<0.05)。结论 多模态超声和FNA对直径≤5 mm TMC均具有较好的临床诊断价值,二者联合更能提高临床诊断准确率。Objective To analyze the diagnostic accuracy of multimodal ultrasound combined with fine needle aspira-tion(FNA)for thyroid microcarcinoma(TMC)≤5 mm in diameter.Methods The clinical data of 120 patients(132 nod-ules)with thyroid micronodules≤5 mm confirmed by surgery and pathology who underwent multimodal ultrasound[two-di-mensional(2D)ultrasound,contra-ultrasound,ultrasonic elastography(UE)]combined with FNA from September 2019 to March 2021 were retrospectively analyzed.The consistency of multimodal ultrasound,FNA and combined detection with path-ological diagnosis was analyzed,and the diagnostic value of single and combined detection was analyzed by receiver operating characteristic(ROC)curve.Results Pathological analysis of 132 thyroid micronodules≤5 mm in diameter showed 36 be-nign nodules and 96 TMC nodules.Compared with the pathological results,the diagnostic coincidence rate of 2-D ultrasound was 85.60%(113/132),and Kappa value was 0.646.The diagnostic coincidence rate of contra-ultrasound was 90.15%(119/132),and Kappa value was 0.758.The diagnostic coincidence rate of UE was 90.15%(119/132),and Kappa value was 0.754.The diagnostic coincidence rate of multimodal ultrasound was 90.91%(120/132),and Kappa value was 0.771.The diagnostic coincidence rate of FNA was 92.42%(122/132),and Kappa value was 0.806.The diagnostic coincidence rate of multimodal ultrasound combined with FNA was 94.70%(125/132),and the Kappa value was 0.860.ROC curve analysis showed that there was no difference in the area under ROC curve(AUC)of the single diagnosis between multimodal ultrasound and FNA(P>005).The AUC of the combined diagnosis of TMC by multimodal ultrasound and FNA was greater than that by single diagnosis(P<005).Conclusion Both multimodal ultrasound and FNA have good clinical diagnostic value for TMC≤5 mm in diameter,and the combination of the two can improve the accuracy of clinical diagnosis.

关 键 词：甲状腺肿瘤 甲状腺结节 超声检查 活组织检查 针吸 弹性成像技术 多模态超声 诊断 ROC曲线 

分 类 号：R736.1[医药卫生—肿瘤]