3种不同方法单独及联合检查对TBSRTCⅢ~Ⅴ类甲状腺结节的诊断价值比较  

Comparison of the value of three different methods for diagnosing TBSRTCⅢ-Ⅴthyroid nodules individually and in combination

作　　者：邵春晖[1] 赵君智 向燃 Shao Chunhui;Zhao Junzhi;Xiang Ran(Department of Ultrasound,Bao Ji People's Hospital,Baoji 721000,Shaanxi Province,China;Department of Ultrasound,Affiliated Bao Ji Hospital of Xi'an Medical University,Baoji 721006,Shaanxi Province,China)

机构地区：[1]宝鸡市人民医院超声科,宝鸡721000 [2]西安医学院附属宝鸡医院超声科,宝鸡721006

出　　处：《中国基层医药》2024年第6期811-816,共6页Chinese Journal of Primary Medicine and Pharmacy

基　　金：陕西省重点研发计划(2023-YBSF-011)。

摘　　要：目的探讨美国放射学会甲状腺影像报告和数据系统(ACR TI-RADS)、实时超声弹性成像(RTE)及超声造影(CEUS)3种不同方法单独及联合诊断甲状腺细胞病理学Bethesda报告系统(TBSRTC)Ⅲ~Ⅴ类甲状腺结节的价值。方法回顾性分析宝鸡市人民医院2022年2月至2023年12月术后病理确诊且术前细针穿刺细胞学检查(FNAC)病理诊断为TBSRTCⅢ~Ⅴ类的甲状腺实性结节106例,均采用ACR TI-RADS分级、RTE及CEUS进行检查,以术后病理诊断为金标准,依据受试者工作特征(ROC)曲线分析ACR TI-RADS、RTE、CEUS单独以及联合对TBSRTCⅢ~Ⅴ类甲状腺结节的诊断效能。结果两组患者一般资料比较,结节大小分布、结节血供分布情况及TBSRTCⅢ~Ⅴ类结节分布比较,差异均有统计学意义(χ^(2)=4.67、42.56、26.09,均P<0.05),其他一般资料比较,差异均无统计学意义(均P>0.05)。106例TBSRTCⅢ~Ⅴ类结节经手术病理确诊恶性结节69例,良性结节37例。ACR-TIRADS、RTE及CEUS诊断甲状腺结节良恶性的曲线下面积(AUC)(95%CI)分别为0.860[95%CI(0.779~0.920)]、0.712[95%CI(0.616~0.796)]及0.788[95%CI(0.698~0.862)],灵敏度分别为85.51%、66.67%及73.91%,特异度分别为86.49%、75.68%及83.78%,约登指数分别为0.719、0.423及0.577;3种检查方法单独检查中ACR TI-RADS诊断效能最高,RTE诊断效能最低。ACR TI-RADS比RTE、ACR TI-RADS比CEUS、RTE比CEUS 3种方法ROC成对比较,差异均有统计学意义(Z=4.22、3.02、2.78,均P<0.05);联合检查方法中ACR TI-RADS+RTE+CEUS组灵敏度、特异度、约登指数及AUC(95%CI)最高,分别为94.20%、89.19%、0.834、0.917[95%CI(0.847~0.962)],RTE+CEUS组灵敏度、特异度、约登指数及AUC(95%CI)最低,分别为76.81%、78.38%、0.552、0.776[95%CI(0.685~0.851)]。联合检查ROC成对比较,ACR TI-RADS+RTE比RTE+CEUS、ACR TI-RADS+RTE比ACR TI-RADS+RTE+CEUS、ACR TI-RADS+CEUS比ACR TI-RADS+RTE+CEUS、RTE+CEUS比ACR TI-RADS+RTE+CEUS、ACR TI-RADS+CEUS比RTE+CEUS差异均有统计Objective To investigate the value of the American College of Radiology Thyroid Imaging,Reporting and Data System(ACR TI-RADS),real-time ultrasound elastography(RTE),and contrast-enhanced ultrasound(CEUS),individually and in combination,in the diagnosis of TBSRTCⅢ-Ⅴthyroid nodules.Methods A retrospective analysis was performed on 106 patients with TBSRTCⅢ-Ⅴthyroid nodules who were pathologically diagnosed by fine needle aspiration cytology at Bao Ji People's Hospital between February 2022 and December 2023.All patients were assessed using ACR TI-RADS grading,RTE,and CEUS,with postoperative pathological diagnosis serving as the gold standard.The diagnostic effectiveness of ACR TI-RADS,RTE,and CEUS,individually and in combination,for TBSRTCⅢ-Ⅴthyroid nodules was analyzed using the receiver operating characteristic(ROC)curve.Results There were statistically significant differences in nodule size,blood supply,and proportion of TBSRTCⅢ-Ⅴnodule between the two groups(χ^(2)=4.67,42.56,26.09,all P<0.05),while there was no statistical significance in other general data(all P>0.05).Of the 106 patients with TBSRTCⅢ-Ⅴnodules,69 patients were diagnosed with malignant nodules and 37 with benign nodules.The area under the curve(95%CI)of ACR-TIRADS,RTE,and CEUS in identifying malignant nodules were 0.860[95%CI(0.779-0.920)],0.712[95%CI(0.616-0.796)],and 0.788[95%CI(0.698-0.862)],respectively,with sensitivities of 85.51%,66.67%,and 73.91%,respectively and specificities of 86.49%,75.68%,and 83.78%,respectively.The Youden indices were 0.719,0.423,and 0.577,respectively.Among the three diagnostic methods,ACR TI-RADS had the highest diagnostic efficiency,while RTE had the lowest.Pairwise comparisons in ROC analysis revealed statistically significant differences between ACR TI-RADS and RTE,ACR TI-RADS and CEUS,as well as RTE and CEUS(Z=4.22,3.02,2.78,all P<0.05).The ACR TI-RADS+RTE+CEUS combination had the highest sensitivity,specificity,Youden index,and AUC(95%CI)values:94.20%,89.19%,0.834,and 0.917(95%CI:0.847-0

关 键 词：甲状腺结节 癌 超声检查 弹性成像技术 内镜超声引导细针穿刺 活组织检查 针吸 静脉造影术 诊断 

分 类 号：R581[医药卫生—内分泌]