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中华诊断学电子杂志 ›› 2021, Vol. 09 ›› Issue (04) : 232 -236. doi: 10.3877/cma.j.issn.2095-655X.2021.04.004

超声诊断

不同方法对甲状腺影像学报告及数据系统4类直径≤1 cm结节良恶性的诊断价值
吴寒1, 汪耘吉2, 蔡尚3, 蒋煊4, 祝玉祥5, 闫彩凤1, 冯尚勇1,()   
  1. 1. 225001 扬州大学附属苏北人民医院内分泌代谢科
    2. 116044 大连医科大学第一临床医学院
    3. 215000 苏州大学附属第二医院肿瘤放射治疗科
    4. 225001 扬州大学附属苏北人民医院超声科
    5. 225001 扬州大学附属苏北人民医院普外科
  • 收稿日期:2020-12-09 出版日期:2021-11-26
  • 通信作者: 冯尚勇
  • 基金资助:
    江苏省自然科学青年基金(BK20180195); 江苏省扬州市重点研发计划(社会发展)项目(YZ2015055)

Diagnostic value on the qualitative diagnosis of the different ways of TI-RADS 4 category thyroid nodules less than or equal to 1 cm

Han Wu1, Yunji Wang2, Shang Cai3, Xuan Jiang4, Yuxiang Zhu5, Caifeng Yan1, Shangyong Feng1,()   

  1. 1. Department of Endocrinology and Metabolism, Northern Jiangsu People′s Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
    2. First Clinical Medical College, Dalian Medical University, Dalian 116044, China
    3. Department of Oncology Radiotherapy, The Second Affiliated Hospital of Soochow University, Suzhou 215000, China
    4. Department of Ultrasound, Northern Jiangsu People′s Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
    5. Department of General Surgery, Northern Jiangsu People′s Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
  • Received:2020-12-09 Published:2021-11-26
  • Corresponding author: Shangyong Feng
引用本文:

吴寒, 汪耘吉, 蔡尚, 蒋煊, 祝玉祥, 闫彩凤, 冯尚勇. 不同方法对甲状腺影像学报告及数据系统4类直径≤1 cm结节良恶性的诊断价值[J/OL]. 中华诊断学电子杂志, 2021, 09(04): 232-236.

Han Wu, Yunji Wang, Shang Cai, Xuan Jiang, Yuxiang Zhu, Caifeng Yan, Shangyong Feng. Diagnostic value on the qualitative diagnosis of the different ways of TI-RADS 4 category thyroid nodules less than or equal to 1 cm[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2021, 09(04): 232-236.

目的

探讨超声引导下细针穿刺细胞学(UG-FNAC)联合BRAFV600E和超声造影(CEUS)对甲状腺影像学报告及数据系统(TI-RADS)4类直径≤1 cm甲状腺结节良恶性的诊断价值。

方法

选择2017年1月至2019年12月扬州大学附属苏北人民医院经手术病理检查证实的98例甲状腺结节患者的105个直径≤1 cm的TI-RADS 4类结节,所有患者术前均进行UG-FNAC、BRAFV600E及CEUS检查,以术后病理诊断结果作为金标准进行对比分析。

结果

手术后组织病理、UG-FNAC、UG-FNAC联合BRAFV600E、CEUS、UG-FNAC联合BRAFV600E联合CEUS对恶性病变的诊断率分别为63.81%(67/105)、43.81%(46/105)、55.24%(58/105)、66.67%(70/105)、53.33%(56/105)。恶性结节均为甲状腺微小乳头状癌(PTMC),UG-FNAC、UG-FNAC联合BRAFV600E、CEUS、UG-FNAC联合BRAFV600E联合CEUS诊断PTMC的敏感度分别为67.16%、83.58%、86.57%、83.58%,特异度分别为97.37%、94.74%、68.42%、100.00%;Kappa值分别为0.58、0.75、0.56、0.79;受试者工作特征(ROC)曲线下面积分别为0.823、0.892、0.775、0.918(均P<0.05)。

结论

UG-FNAC联合BRAFV600E联合CEUS诊断TI-RADS 4类直径≤1 cm甲状腺结节具有较高的准确性和诊断价值。

Objective

To compare the diagnostic value of ultrasound-guided fine needle aspiration cytology (UG-FNAC) combined with BRAFV600E gene mutation and contrast-enhanced ultrasound (CEUS) for thyroid imaging reporting and data system (TI-RADS) type 4 thyroid nodules less than or equal to 1 cm.

Methods

From January 2017 to December 2019, 98 patients with 105 TI-RADS type 4 thyroid nodules less than or equal to 1 cm confirmed by surgery and pathological examination in Northern Jiangsu People′s Hospital Affiliated to Yangzhou University were analyzed, UG-FNAC, BRAFV600E and CEUS were performed before surgery. The results were compared with surgical pathology which regarded as the " gold standard" .

Results

The diagnostic rates of malignancy (number of malignancy) were 63.81%(67/105), 43.81%(46/105), 55.24%(58/105), 66.67%(70/105), and 53.33%(56/105) for histopathology of surgery, UG-FNAC, UG-FNAC combined with BRAFV600E, CEUS, UG-FNAC and BRAFV600E combined with CEUS, respectively, and all malignant nodules were papillary thyroid microcarcinoma (PTMC). The sensitivities of UG-FNAC, UG-FNAC combined with BRAFV600E, CEUS, UG-FNAC and BRAFV600E combined with CEUS were 67.16%, 83.58%, 86.57%, 83.58%, and the specificities were 97.37%, 94.74%, 68.42%, 100.00%, respectively. The Kappa values of UG-FNAC, UG-FNAC combined with BRAFV600E, CEUS, UG-FNAC and BRAFV600E combined with CEUS were 0.58, 0.75, 0.56, 0.79, and the areas under the curve of receiver operating characteristic (ROC) were 0.823, 0.892, 0.775, 0.918 (all P<0.05), respectively.

Conclusion

UG-FNAC and BRAFV600E combined with CEUS has higher accuracy and diagnostic value in the diagnosis of TI-RADS type 4 thyroid nodules less than or equal to 1 cm.

表1 两组甲状腺结节患者临床资料比较
表2 不同方法对两组甲状腺结节诊断的结果分布比较(个)
表3 不同方法诊断甲状腺结节良恶性的诊断效能比较
图1 不同方法诊断甲状腺结节良恶性的ROC曲线
[1]
Moon JH, Hyun MK, Lee JY,et al.Prevalence of thyroid nodules and their associated clinical parameters:a large-scale,multicenter-based health checkup study[J].Korean J Intern Med201833(4):753-762.
[2]
冯尚勇,朱妍,张真稳,等.江苏社区人群甲状腺结节的流行病学研究[J].中华内分泌代谢杂志201127(6):492-494.
[3]
Horvath E, Majlis S, Rossi R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management[J].J Clin Endocrinol Metab200994(5):1748-1751.
[4]
Chen HY, Liu WY, Zhu H, et al. Diagnostic value of contrast-enhanced ultrasound in papillary thyroid microcarcinoma[J].Exp Ther Med201611(5):1555-1562.
[5]
Cibas ES, Ali SZ.The 2017 Bethesda system for reporting thyroid cytopathology[J].Thyroid201727(11):1341-1346.
[6]
王冰,郗洪庆,万政,等.单中心9 662例甲状腺癌流行病学特征及临床病理特征分析[J].中华内分泌外科杂志202115(4):342-347.
[7]
田文,孙辉,贺青卿.超声引导下甲状腺结节细针穿刺活检专家共识及操作指南(2018版)[J].中国实用外科杂志201838(3):241-244.
[8]
龚丽媛,陈光勇,黄娟颖,等.超声指引下细针穿刺活检对甲状腺微小癌的诊断价值[J].临床合理用药杂志202013(14):167-169.
[9]
刘云,陈松旺.超声引导下细针穿刺抽吸活检在甲状腺微小结节定性诊断中的价值[J].肿瘤影像学201928(1):42-45.
[10]
Liu R, Bishop J, Zhu G,et al.Mortality risk stratification by combining BRAFV600E and TERT promoter mutations in papillary thyroid cancer:genetic duet of BRAF and TERT promoter mutations in thyroid cancer mortality[J].JAMA Oncol20173(2):202-208.
[11]
吕志红,俞磊,韩鄂辉,等.超声造影在甲状腺结节鉴别诊断中的价值[J/CD].中华诊断学电子杂志20164(2):73-77.
[12]
Zhang Y, Luo YK, Zhang MB, et al. Diagnostic accuracy of contrast-enhanced ultrasound enhancement patterns for thyroid nodules[J].Med Sci Monit2016(22):4755-4764.
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