Diagnostic value of gray scale ultrasound, color Doppler ultrasound and shear wave elastography Young's modulus in papillary thyroid microcarcinoma
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摘要:
目的 探讨灰阶超声、多普勒超声及剪切波杨氏模量诊断甲状腺微小乳头状癌的价值。 方法 选择2018年2月~2020年5月由我院诊治的甲状腺结节患者136例，分别进行灰阶超声、多普勒超声及剪切波杨氏模量技术及病理学检查，以病理诊断为金标准，分析灰阶超声、多普勒超声及剪切波杨氏模量和三者联合诊断甲状腺微小乳头状癌的价值。 结果 灰阶超声敏感度43.21%，特异性68.30%，准确度57.30%；多普勒超声敏感度75.32%，特异性90.74%，准确度84.32%；根据病理结果分为良性、恶性组进行ME值比较，良性组MEmean、MEmin、MEmax值明显低于恶性组（P < 0.05）；MEmean、MEmin和MEmax预测微小乳头状态癌的ROC曲线最佳切值点分别为40.25、16.85、65.92 kPa，其对应的敏感度和特异性分别为85.5%、68.8%，67.5%、82.4%，58.1%、88.2%；联合检测准确度高于灰阶、多普勒超声、剪切波杨氏准确度，差异有统计学意义（P < 0.05）。 结论 灰阶超声、多普勒超声及剪切波杨氏模量三者联合诊断甲状腺微小乳头状癌可提高其诊断准确率，具有较高诊断价值。 Abstract:Objective To investigate the diagnostic value of gray scale ultrasound, Doppler ultrasound and shear wave elastography Young's modulus in papillary thyroid microcarcinoma. Methods A total of 136 patients with papillary thyroid microcarcinoma in our hospital from February 2018 to May 2020 were enrolled. Gray scale ultrasound, Doppler ultrasound, shear wave elastography Young's modulus and pathological examination were performed, respectively. Taking pathological examination results as golden standards, the value of remaining three methods in the diagnosis of papillary thyroid microcarcinoma was analyzed. Results The sensitivity, specificity and accuracy of gray-scale ultrasound were 43.21%, 68.30% and 57.30%, respectively, and those of Doppler ultrasound were 75.32%, 90.74% and 84.32%, respectively. Based on pathological examinations, patients were divided into benign group and malignant group for ME value comparison. Values of MEmean, MEmin and MEmax in benign group were significantly lower than those in malignant group (P < 0.05). The optimal ROC curve cutoff points of MEmean, MEmin and MEmax for predicting thyroid microcarcinoma were 40.25, 16.85 and 65.92 kPa, respectively, and the corresponding sensitivity and specificity were 85.5%, 68.8%, 67.5%, 82.4%, 58.1%, and 88.2%, respectively. The accuracy of combined examinations was significantly higher than that of single examination (P < 0.05). Conclusion Combined examinations of gray scale ultrasound, Doppler ultrasound and shear wave elastography Young's modulus in papillary thyroid microcarcinoma has a high diagnosis accuracy. -
图 1 女，42岁，病理结果为甲状腺微小乳头状癌
A~B：甲状腺右侧叶下极可见一低回声结节，边界欠清，形态规则，纵横径比<1，内回声欠均匀，内可见粗大钙化，大小0.94 cm×0.76 cm；C：甲状腺右侧叶内未见明显血流信号；D：低回声结节呈蓝绿渲染，以蓝色渲染为主，评分3分.
Figure 1. Images of a 42-year-old woman with pathologically confirmed papillary thyroid microcarcinoma
图 2 ME界值诊断甲状腺微小乳头状癌的ROC曲线
Figure 2. ROC curve of me cutoff value in diagnosis of papillary thyroid microcarcinoma
表 1 灰阶超声与病理诊断甲状腺微小乳头状癌性质准确性比较
Table 1. Accuracy comparison of gray scale ultrasound and pathology in the diagnosis of papillary thyroid microcarcinoma (n)
灰阶超声 病理 合计 良性 恶性 良性 35 46 81 恶性 33 71 104 合计 68 117 185 
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表 2 多普勒超声技术与病理诊断甲状腺微小乳头状癌性质准确性比较
Table 2. Comparison of the accuracy of Doppler ultrasound and pathology in the diagnosis of papillary thyroid microcarcinoma (n)
多普勒超声 病理 合计 良性 恶性 良性 58 19 77 恶性 10 98 108 合计 68 117 185
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表 3 两组剪切波杨氏模量测定结果
Table 3. Measurement results of Young's modulus of two groups of shear waves (kPa, Mean±SD)
组別 MEmean MEmin MEmax 良性组
（n=68）32.12±20.87 16.68±5.76 51.55±11.43 恶性组
（n=117）51.67±10.56 27.30±8.54 68.58±17.13 t 8.451 9.115 7.303 P < 0.001 < 0.001 < 0.001
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表 4 联合检测结果准确性比较
Table 4. Accuracy comparison of combined detection results(n)
联合 病理 合计 良性 恶性 良性 62 8 70 恶性 6 109 115 合计 68 117 185
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