Clinical value of evaluating benign and malignant thyroid nodules by hemodynamic parameters instead of ultrasound
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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
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图 1 典型案例
患者女性, 47岁, 因发现颈部肿块1年来就诊.A: 超声图像; B~C: 彩色多普勒血流图像; D: 血流动力图.
Figure 1. Diagram of typical case.
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. 
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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
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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
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