Value of contrast-enhanced ultrasound combined with fine needle aspiration biopsy in the diagnosis of thyroid nodules
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摘要:
目的 探讨超声造影结合细针穿刺活检在诊断甲状腺结节方面的临床价值。 方法 观察我院98例甲状腺结节患者的98个结节,每例患者依次进行二维超声检查及超声造影后,再在超声引导下行细针穿刺活检。以手术病理为标准,评价超声造影及细针穿刺活检对甲状腺结节诊断的准确性。 结果 98例甲状腺结节患者,手术病理诊断良性结节40例,恶性结节58例,超声造影及细针穿刺活检诊断甲状腺结节的敏感性、特异性、准确性分别为72%、68%、70%及78%、73%、76%;超声造影结合细针穿刺活检诊断甲状腺结节的敏感性为91%、特异性为90%、准确性为90%,两种检查方法结合可提高甲状腺结节诊断的敏感性、特异性和准确性,差异有统计学意义(P<0.05)。 结论 超声造影结合细针穿刺活检可在术前更准确、更安全的判断甲状腺结节的良恶性,对甲状腺结节的诊断具有重要的临床意义。 Abstract:Objective To study the clinical application value of contrast-enhanced ultrasound combined with fine needle aspiration biopsy in the diagnosis of thyroid nodules. Methods Ninety-eight thyroid nodules from 98 patients in our hospital were observed. Patients were performed with the examination of two-dimensional ultrasound and contrast-enhanced ultrasound.Then they accepted fine needle aspiration biopsy under ultrasound guidance. According to surgical pathology, the accuracy of contrast-enhanced ultrasound and fine needle aspiration biopsy in the diagnosis of thyroid nodules were evaluated. Results In 98 cases of thyroid nodules, 40 cases were surgical pathologic diagnosis of benign nodules, 58 cases of malignant nodules. The sensitivity, specificity and accuracy of contrast-enhanced ultrasound and fine needle aspiration in diagnosis of thyroid nodules were 72%, 68%, 70% and 78%, 73%, 76%. Contrast-enhanced ultrasound combined with fine needle biopsy in the diagnosis of thyroid nodules got the sensitivity of 91%, specificity of 90%, accuracy of 90%. The sensitivity specificity and accuracy of thyroid nodule diagnosis were significantly improved by combination of two methods of examination, and the difference was statistically significant(P<0.05). Conclusion Contrast-enhanced ultrasound combined with fine needle aspiration biopsy can be accurate and safe to judge benign and malignant thyroid nodules.It has important clinical significance for the diagnosis of thyroid nodule. -
Key words:
- contrast-enhanced ultrasound /
- fine needle aspiration /
- thyroid nodules
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表 1 超声造影、细针穿刺活检及超声造影结合细针穿刺活检诊断甲状腺结节敏感性、特异性、准确性的比较(n,%)
检查方法 敏感性 特异性 准确性 超声造影 72(42/58) 68(27/40) 70(69/98) 细针穿刺活检 78(45/58)a 73(29/40)a 76(74/98)a 超声造影结合细针穿刺活检 91(53/58)bc 90(36/40)bc 90(88/98)bc χ2 7.092 6.242 11.758 P 0.029 0.044 0.003 aP>0.05vs超声造影; bP<0.05vs超声造影; cP<0.05vs细针穿刺活检. -
[1] Führer D, Mügge C, Paschke R. Questionnaire on management of nodular thyroid disease (Annual Meeting of the Thyroid Section of the German Society of Endocrinology 2003)[J]. Exp Clin Endocrinol Diabetes, 2005, 113(3): 152-9. doi: 10.1055/s-2005-837523 [2] Lawrence W, Kaplan BJ. Diagnosis and management of patients with thyroid nodules[J]. J Surg Oncol, 2002, 80(3): 157-70. doi: 10.1002/(ISSN)1096-9098 [3] 潘景升, 秦 威, 邓宝雯, 等. 超声造影结合粗针活检诊断甲状腺结节的临床应用价值[J]. 岭南现代临床外科, 2013, 13(5): 424-6. http://d.wanfangdata.com.cn/Periodical/lnxdlcwk201305016 [4] 吴 亮, 杨顺实, 江学庆, 等. 超声引导下甲状腺结节细针穿刺细胞学检查的术前诊断价值[J]. 中国临床医学影像杂志, 2014, 25(1): 17-20. http://d.wanfangdata.com.cn/Periodical/zglcyxyxzz201401005 [5] Zhang B, Jiang YX, Liu JB, et al. Utility of contrast-enhanced ultrasound for evaluation of thyroid nodules[J]. Thyroid, 2010, 20(1): 51-7. doi: 10.1089/thy.2009.0045 [6] 严佳梅, 黄品同, 游向东, 等. 超声造影结合细针穿刺对甲状腺癌的诊断价值[J]. 中华超声影像学杂志, 2014, 23(3): 222-6. http://d.wanfangdata.com.cn/Periodical/zhcsyx201403016 [7] 刘 丽. 超声造影在甲状腺癌诊断中的应用现状及前景[J]. 中外医疗, 2015, 34(15): 175-6. doi: 10.3969/j.issn.1674-0742.2015.15.086 [8] 李 卫, 张自雄. 65例甲状腺癌的临床分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2014, 22(3): 212-4. http://d.wanfangdata.com.cn/Periodical/zgzxyjhebyhkzz201403017 [9] 朱 正, 徐新艳, 顾国建, 等. 超声引导下细针穿刺细胞学检查对甲状腺囊实性结节的诊断价值[J]. 中华超声影像学杂志, 2014, 23(12): 1088-9. doi: 10.3760/cma.j.issn.1004-4477.2014.12.023 [10] 路晓荔, 杨凯华, 杜联芳. 超声造影在甲状腺结节诊断中的应用价值[J]. 生物医学工程与临床, 2014, 18(2): 200-3. http://d.wanfangdata.com.cn/Thesis/Y3120271 [11] 李 杰, 董宝玮, 于晓玲, 等. 肝不同部位灰阶超声造影定量分析的实验研究[J]. 中华超声影像学杂志, 2004, 13(6): 460-2. http://d.wanfangdata.com.cn/Periodical/zhcsyx200406016 [12] 张 波, 姜玉新, 戴 晴, 等. 前瞻性观察甲状腺结节的SonoVue超声造影增强模式[J]. 中国医学影像技术, 2010, 26(5): 844-7. http://d.wanfangdata.com.cn/Periodical/zgyxyxjs201005016 [13] Frates MC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement[J]. Radiology, 2005, 237(3): 794-800. doi: 10.1148/radiol.2373050220 [14] American Thyroid Association, Cooper DS, Doherty GM, et al. Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid, 2009, 19(11): 1167-214. doi: 10.1089/thy.2009.0110 [15] Burch HB, Burman KD, Reed HL, et al. Fine needle aspiration of thyroid nodules. Determinants of insufficiency rate and malignancy yield at thyroidectomy[J]. Acta Cytol, 1997, 40(6): 1176-83. [16] Ravetto C, Colombo L, Dottorini ME. Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients[J]. Cancer, 2000, 90(6): 357-63. doi: 10.1002/1097-0142(20001225)90:6<>1.0.CO;2-Z [17] Schoedel KE, Tublin ME, Pealer K, et al. Ultrasound-guided biopsy of the thyroid: a comparison of technique with respect to diagnostic accuracy[J]. Diagn Cytopathol, 2008, 36(11): 787-9. doi: 10.1002/dc.v36:11 [18] Kim DW, Lee EJ, Kim SH, et al. Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules: comparison in efficacy according to nodule size[J]. Thyroid, 2009, 19(1): 27-31. doi: 10.1089/thy.2008.0106 [19] Moon WJ, Baek JH, Jung SL, et al. Ultrasonography and the ultrasound-based management of thyroid nodules: consensus statement and recommendations[J]. Korean J Radiol, 2011, 12(1): 1-14. doi: 10.3348/kjr.2011.12.1.1 [20] Cardella JF, Bakal CW, Bertino RE, et al. Quality improve-ment guidelines for image-guided percutaneous biopsy in adults[J]. J Vasc Interv Radiol, 2003, 14(9 Pt 2): S227-30.