Diagnostic value of ultrasound-guided fine needle aspiration combined with contrast-enhanced ultrasonography and TI-RADS classification criteria for benign and malignant thyroid nodules
-
摘要:
目的 研究超声引导下细针穿刺(US-FNA)联合超声造影(CEUS)及甲状腺影像报告数据系统分类标准对甲状腺良恶性结节中的诊断价值。 方法 选择2020年1月~2021年6月在海南西部中心医院诊治的110例甲状腺结节患者作为研究对象, 共134个结节。所有患者均行US-FNA检查和CEUS检查, 比较单独检查和联合检查的结果, 对比敏感度、特异性、准确率、阳性预测值及阴性预测值。 结果 US-FNA检查的敏感度、特异性、准确率、阳性预测值及阴性预测值分别为96.23%、85.71%、94.03%、96.23%和85.71%, CEUS检查为92.45%、42.86%、82.09%、85.96%和60.00%, 联合检查为100.00%、28.57%、85.07%、77.94%和100.00%, 3种方法的敏感度、准确率、阳性预测值、阴性预测值比较, 差异无统计学意义(P>0.05), 但US-FNA检查的特异性高于CEUS检查和联合检查(P<0.05)。 结论 US-FNA检查在甲状腺良恶性结节诊断方面的特异性较高, US-FNA与CEUS联合检查并未有效提高检测的准确率和敏感度。 -
关键词:
- 细针穿刺 /
- 超声造影 /
- 甲状腺影像报告数据系统 /
- 甲状腺结节
Abstract:Objective To explore the diagnostic value of ultrasound-guided fine needle aspiration (US-FNA) combined with contrast-enhanced ultrasonography (CEUS) and TI-RADS classification criteria for thyroid benign and malignant nodules. Methods From January 2020 to June 2021, 110 patients with thyroid nodules (totally 134 nodules) in Hainan Western Central Hospital were selected as the research objects.All patients were underwent US-FNA examination and CEUS examination.The results of individual examination and combined examination were compared, and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were compared. Results The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of US-FNA examination were 96.23%, 85.71%, 94.03%, 96.23% and 85.71%, CEUS examination were 92.45%, 42.86%, 82.09%.85.96% and 60.00%, the combined inspection were 100.00%, 28.57%, 85.07%, 77.94% and 100.00%.The comparison of the sensitivity, accuracy, positive predictive value, and negative predictive value of the three methods were not statistically significant (P>0.05), but the specificity of US-FNA examination were significantly higher than that of CEUS examination and combined examination (P<0.05). Conclusion The US-FNA examination is highly specific in the diagnosis of benign and malignant thyroid nodules.The combined examination of US-FNA and CEUS has not effectively improved the accuracy and sensitivity of the detection. -
图 2 甲状腺恶性结节的CEUS典型图像
A: 甲状腺右叶中段实质内可见单个低回声结节, 边界清, 内回声不均匀, 结节伴散在细小点状钙化; B: 甲状腺右叶低回声结节, 横切面示大小约5 mm×7 mm, 纵横比 > 1, 边界清, 内回声不均匀,结节伴散在细小点状钙化; C: 甲状腺右叶低回声结节周边及内部血供稀少; D: 注射造影后,第9秒甲状腺右叶中段病灶呈低增强; E: 注射造影后, 第43秒甲状腺右叶中段病灶呈低增强, F: 注射造影后, 1 min 31 s甲状腺右叶中段病灶呈低增强.
Figure 2. Typical CEUS images of thyroid malignant nodules.
表 1 三种方法的检查结果
Table 1. Inspection results of three methods (n)
方法 检查结果 病检结果 恶性 良性 CEUS检查 恶性 98 16 良性 8 12 US-FNA检查 恶性 102 4 良性 4 24 联合检查 恶性 106 20 良性 0 8 CEUS: 超声造影; US-FNA: 超声引导下细针穿刺. 表 2 三种方法的诊断效果比较
Table 2. Comparison of diagnostic effects of three methods (%)
方法 敏感度 特异性 准确率 阳性预测值 阴性预测值 CEUS检查 92.45(98/106) 42.86(12/28) 82.09(110/134) 85.96(98/114) 60.00(12/20) US-FNA检查 96.23(102/106) 85.71(24/28) 94.03(126/134) 96.23(102/106) 85.71(24/28) 联合检查 100.00(106/106) 28.57(8/28) 85.07(114/134) 77.94(106/136) 100.00(88/88) -
[1] 任玲, 罗渝昆, 宋青, 等. 超声造影及弹性成像技术对超声造影无增强甲状腺结节良恶性的鉴别诊断价值[J]. 中华医学超声杂志: 电子版, 2020, 17(6): 552-7. doi: 10.3877/cma.j.issn.1672-6448.2020.06.012 [2] 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 [3] 卓娜, 孙彤, 李晨运, 等. 超声造影检查对甲状腺恶性结节的诊断效能分析[J]. 山东医药, 2020, 60(8): 61-4. doi: 10.3969/j.issn.1002-266X.2020.08.016 [4] 程颢, 田燕, 冯海波, 等. 超声造影在评价TI-RADS 4类甲状腺囊性皱缩结节中的临床应用[J]. 中国超声医学杂志, 2020, 36(7): 595-8. doi: 10.3969/j.issn.1002-0101.2020.07.007 [5] 孟盈, 姚晓华, 王静, 等. ACR TI-RADS联合超声造影诊断甲状腺结节良恶性的价值[J]. 中国超声医学杂志, 2020, 36(11): 980-3. doi: 10.3969/j.issn.1002-0101.2020.11.005 [6] 曹春莉, 陈铭, 杜婷婷, 等. 超声造影联合二维超声在TI-RADS 4类甲状腺结节良恶性鉴别诊断中的应用价值[J]. 实用医学杂志, 2019, 35(18): 2954-8. doi: 10.3969/j.issn.1006-5725.2019.18.027 [7] 马淑梅, 闫瑞斌, 冯桃桃. 超声造影成像及参数特征对甲状腺TI-RADS 4类结节良恶性的诊断价值[J]. 中国超声医学杂志, 2019, 35(10): 868-72. doi: 10.3969/j.issn.1002-0101.2019.10.002 [8] Caresio C, Caballo M, Deandrea M, et al. Quantitative analysis of thyroid tumors vascularity: a comparison between 3-D contrast-enhanced ultrasound and 3-D Power Doppler on benign and malignant thyroid nodules[J]. Med Phys, 2018, 45(7): 3173-84. doi: 10.1002/mp.12971 [9] 李霞, 肖迎聪. 超声引导下甲状腺结节细针穿刺细胞学与粗针穿刺组织学检查的对比研究[J]. 肿瘤防治研究, 2020, 47(9): 680-3. doi: 10.3971/j.issn.1000-8578.2020.19.1606 [10] 赵媛, 赵永刚, 张春芳, 等. 超声、细针穿刺细胞学及BRAFV600E基因对甲状腺结节的诊断价值[J]. 实用医学杂志, 2020, 36(24): 3420-4. doi: 10.3969/j.issn.1006-5725.2020.24.023 [11] 廖丽燕, 易文君, 汪洋, 等. 细针穿刺与对比增强超声对TI-R A DS 4类甲状腺结节诊断价值的比较[J]. 中南大学学报: 医学版, 2019, 44(9): 1071-7. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYD201909020.htm [12] 魏玺, 王晓庆, 王猛, 等. 细针穿刺活检结合分子检测在甲状腺结节鉴别诊断中的研究进展[J]. 中国肿瘤临床, 2018, 45(1): 33-6. doi: 10.3969/j.issn.1000-8179.2018.01.871 [13] Poller DN, Johnson SJ, Bongiovanni M. Measures to reduce diagnostic error and improve clinical decision making in thyroid FNA aspiration cytology: a proposed framework[J]. Cancer Cytopathol, 2020, 128(12): 917-27. doi: 10.1002/cncy.22309 [14] 冯占武, 丛淑珍, 甘科红, 等. 超声及细针穿刺细胞学检查诊断甲状腺良恶性结节[J]. 中国超声医学杂志, 2019, 35(9): 772-5. doi: 10.3969/j.issn.1002-0101.2019.09.002 [15] 李晨, 李建宁, 杨裕辉, 等. 超声引导下细针穿刺细胞学检查在甲状腺微小结节良恶性鉴别诊断中的应用价值[J]. 中国临床医学影像杂志, 2017, 28(3): 223-5. doi: 10.3969/j.issn.1008-1062.2017.03.019 [16] Nikiforov YE. Role of molecular markers in thyroid nodule management: then and now[J]. Endocr Pract, 2017, 23(8): 979-89. doi: 10.4158/EP171805.RA [17] 钟绍斌, 彭川, 邹学彬, 等. 美国甲状腺协会超声分类与细针穿刺细胞学检查诊断良恶性甲状腺结节[J]. 中国医学影像技术, 2017, 33(11): 1647-51. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX201711015.htm [18] 石尖兵, 邓瑶瑶, 晋红, 等. 应用高频超声鉴别诊断伴环形钙化甲状腺良恶性结节的价值研究[J]. 川北医学院学报, 2018, 33(6): 873-6. doi: 10.3969/j.issn.1005-3697.2018.06.018 [19] 忻晓洁, 孙成相, 王晓庆, 等. 超声引导下细针穿刺活检对≤10 mm TI-RADS 4a类甲状腺结节的诊断价值[J]. 中华普通外科杂志, 2016, 31(8): 673-6. doi: 10.3760/cma.j.issn.1007-631X.2016.08.018 [20] 章林丽, 施娜, 杨艳婷, 等. 超声造影评分法联合TI-RADS分类鉴别诊断甲状腺结节价值探讨[J]. 川北医学院学报, 2021, 36(1): 76-9. doi: 10.3969/j.issn.1005-3697.2021.01.018 [21] 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 [22] 孙永清, 刘利平, 史艳平, 等. 超声造影联合细针抽吸活检对甲状腺良恶性结节的鉴别诊断价值[J]. 中华超声影像学杂志, 2018, 27(10): 875-80. doi: 10.3760/cma.j.issn.1004-4477.2018.10.011 [23] Trimboli P, Castellana M, Virili C, et al. Performance of contrast-enhanced ultrasound (CEUS) in assessing thyroid nodules: a systematic review and meta-analysis using histological standard of reference[J]. Radiol med, 2020, 125(4): 406-15. doi: 10.1007/s11547-019-01129-2