Clinical value of evaluating benign and malignant thyroid nodules by hemodynamic parameters instead of ultrasound
-
摘要:
目的 分析超声通过血流动力学参数评估甲状腺结节良恶性及其诊断的敏感度和特异性。 方法 选择2020年6月~2022年1月收治的122例甲状腺结节患者,依照病理检测结果将患者分为良性结节组(n=78)和恶性结节组(n=44),对患者进行彩色超声扫描检查,术后切除的组织样品行常规病理学检查。以病理诊断结果为金标准,绘制ROC曲线分析各指标单独应用及联合应用评估甲状腺结节良恶性的敏感度和特异性。 结果 良性结节组患者病灶区收缩期峰值流速(PSV)及阻力指数(RI)值均明显低于恶性结节组,舒张末期血流速度(EDV)水平高于恶性结节组(P < 0.05);PSV、EDV及RI联合应用预测甲状腺结节良恶性预测价值为Log(P)=-0.654×PSV+0.627×EDV-0.608×RI+0.613;PSV、EDV及RI联合应用预测甲状腺结节良恶性敏感度、特异度及曲线下面积均明显高于各指标单独应用(P < 0.05)。 结论 通过超声扫描检查血流动力学参数评估甲状腺结节良恶性具有较高的敏感度和特异性。 Abstract:Objective To explore the sensitivity and specificity of ultrasound in the evaluation of benign and malignant thyroid nodules by hemodynamic parameters. Methods A total of 122 patients with thyroid nodules treated from June 2020 to January 2022 were selected. They were divided into benign nodule group (n=78) and malignant nodule group (n=44) according to the pathological results. The patients were examined by color ultrasound, and the resected tissues were examined by routine pathology. Taking the pathological diagnosis results as the gold standard, the ROC curve was drawn to analyze the sensitivity and specificity of each index used alone and in combination to evaluate the benign and malignant thyroid nodules. Results the values of peak systolic velocity (PSV) and resistance index (RI) in the lesion area in the benign nodule group were lower than the malignant nodule group, and the level of end diastolic velocity (EDV) was higher than the malignant nodule group (P < 0.05). The predictive value of PSV, EDV and RI in predicting benign and malignant thyroid nodules was log(P)=-0.654×PSV+ 0.627× EDV-0.608× RI +0.613; The sensitivity, specificity and AUC of combined application of PSV, EDV and RI in predicting benign and malignant thyroid nodules were significantly higher than those of single application (P < 0.05). Conclusion Ultrasonographic examination of hemodynamic parameters has high sensitivity and specificity in evaluating benign and malignant thyroid nodules. -
Key words:
- hemodynamic parameters /
- thyroid nodules /
- benign and malignant /
- sensitivity /
- specificity
-
表 1 不同组别患者血流动力学参数检测结果
Table 1. Hemodynamic parameters test results of patients in different groups (Mean±SD)
组别 PSV(cm/s) EDV(cm/s) RI 良性结节组(n=78) 30.02±4.96 17.32±3.21 0.46±0.05 恶性结节组(n=44) 34.41±3.47 14.23±2.99 0.81±0.12 t 5.720 3.613 18.464 P < 0.001 0.001 < 0.001 PSV: 收缩期峰值流速; EDV: 舒张末期血流速度; RI: 阻力指数. 表 2 血流动力学参数联合应用预测甲状腺结节良恶性模型分析
Table 2. Analysis of combined application of hemodynamic parameters in predicting benign and malignant thyroid nodules
指标 b SE χ2 P OR 95% CI 下限 上限 PSV -0.654 0.231 8.016 0.005 0.520 0.331 0.818 EDV 0.627 0.218 8.272 0.004 1.872 1.221 2.870 RI值 -0.608 0.203 8.970 0.003 0.544 0.366 0.810 常数项 0.613 0.226 7.357 0.007 1.846 1.185 2.875 表 3 各指标单独及联合应用预测甲状腺结节良恶性价值
Table 3. Predicting benign and malignant thyroid nodules by single and combined use of each index
指标 敏感度(%) 特异性(%) 曲线下面积 SE P 95% CI 下限 上限 PSV 79.55 87.18 0.838 0.035 < 0.001 0.769 0.907 EDV 70.45 78.21 0.749 0.047 < 0.001 0.657 0.841 RI值 84.09 89.74 0.858 0.039 < 0.001 0.782 0.935 联合应用 90.91 96.15 0.939 0.028 < 0.001 0.884 0.995 -
[1] Idrees A, Shahzad R, Fatima I, et al. Strain elastography for differentiation between benign and malignant thyroid nodules[J]. J Coll Physicians Surg Pak, 2020, 30(4): 369-72. doi: 10.29271/jcpsp.2020.04.369 [2] Wise E, Hocking K, Polcz M, et al. 1174: investigation of hemodynamic parameters using a porcine hemorrhage and volume overload model[J]. Crit Care Med, 2021, 49(1): 589. [3] Gerashchenko M, Markuleva M. Nonlinear SVD-filtration in hemodynamic parameters evaluation hydrocuff systems[J]. J Phys, 2020, 1515(5), 52041. [4] 毛森, 赵鲁平, 李小花, 等. 2020中国超声甲状腺影像报告和数据系统在甲状腺结节鉴别诊断中的应用价值[J]. 中华医学杂志, 2021, 101(45): 3748-53. doi: 10.3760/cma.j.cn112137-20210401-00799 [5] Miao SM, Jing M, Sheng RR, et al. The analysis of differential diagnosis of benign and malignant thyroid nodules based on ultrasound reports[J]. Gland Surg, 2020, 9(3): 653-60. doi: 10.21037/gs.2020.04.03 [6] 马姣姣, 孙脉, 田艳, 等. 超声造影定量参数在甲状腺良恶性结节鉴别诊断中的价值[J]. 中国医学科学院学报, 2020, 42(1): 80-5. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYKX202001012.htm [7] Styazhkina SN, Idiatullin RM, Akhmadullina AS. Specificity and sensitivity (expediency) of urgent histological study of surgical material in diagnosis of benign thyroid tumors[J]. Perm Med J, 2020, 37(1): 79-84. doi: 10.17816/pmj37179-84 [8] Vest JR, Wu W, Mendonca EA. Sensitivity and specificity of real-world social factor screening approaches[J]. J Med Syst, 2021, 45 (12): 111. doi: 10.1007/s10916-021-01788-7 [9] Bian YT, Jin P, Wang YL, et al. Clinical applications of DSC-MRI parameters assess angiogenesis and differentiate malignant from benign soft tissue tumors in limbs[J]. Acad Radiol, 2020, 27(3): 354-60. doi: 10.1016/j.acra.2019.04.023 [10] Chambara N, Liu SYW, Lo X, et al. Diagnostic performance evaluation of different TI-RADS using ultrasound computer-aided diagnosis of thyroid nodules: an experience with adjusted settings[J]. PLoS One, 2021, 16(1): e0245617. doi: 10.1371/journal.pone.0245617 [11] 韩广香, 周春艳, 郑辉. 二维超声与彩色多普勒超声诊断甲状腺良恶性结节的临床应用价值[J]. 影像研究与医学应用, 2018, 2(12): 150-1. doi: 10.3969/j.issn.2096-3807.2018.12.095 [12] 黄哲英, 杨涛. 彩色多普勒超声在甲状腺结节良恶性肿瘤疾病鉴别诊断中的应用[J]. 浙江创伤外科, 2019, 24(5): 1061-2. doi: 10.3969/j.issn.1009-7147.2019.05.095 [13] 李炜, 潘丽霞. 彩色多普勒超声在甲状腺良恶性结节诊断中的应用价值[J]. 医疗装备, 2020, 33(17): 29-30. doi: 10.3969/j.issn.1002-2376.2020.17.010 [14] 冯国平, 门杰. 彩色多普勒超声成像及定量参数用于鉴别诊断甲状腺结节良恶性的价值观察[J]. 实用医技杂志, 2022, 29(4): 414-7. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYJ202204024.htm [15] Kong QF, Lv B, Wang B, et al. Association of von Willebrand factor (vWF) expression with lymph node metastasis and hemodynamics in papillary thyroid carcinoma[J]. Eur Rev Med Pharmacol Sci, 2020, 24(5): 2564-71. [16] 方娣, 姚晓漫, 孙文静, 等. 甲状腺结节良恶性的彩色多普勒超声特征及其诊断价值分析[J]. 现代生物医学进展, 2020, 20(1): 158-61. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX202001036.htm [17] 刘明雨, 陈然, 王伟. 彩色多普勒超声对甲状腺结节良恶性的鉴别诊断价值及不同性质甲状腺结节的超声表现[J]. 湖南师范大学学报: 医学版, 2020, 17(6): 125-8. doi: 10.3969/j.issn.1673-016X.2020.06.038 [18] 宋青, 田晓琦, 兰雨, 等. 常规超声联合超声造影诊断部分囊性甲状腺结节良恶性的价值[J]. 中国医学影像学杂志, 2020, 28(3): 189-93. doi: 10.3969/j.issn.1005-5185.2020.03.008 [19] 王雨. 高频彩色多普勒超声鉴别诊断甲状腺良恶性结节的临床价值[J]. 中国现代普通外科进展, 2020, 23(9): 730-2, 736. https://www.cnki.com.cn/Article/CJFDTOTAL-PWJZ202009017.htm [20] 王伟镇, 李颖嘉, 刘志, 等. 超声与细针穿刺诊在甲状腺结节诊断中的价值比较[J]. 分子影像学杂志, 2019, 42(2): 214-6. doi: 10.12122/j.issn.1674-4500.2019.02.17