甲状腺影像报告与数据系统联合超声弹性成像对甲状腺良恶性结节的诊断价值

摘要

目的：评价甲状腺影像报告与数据系统（TI-RADS）联合超声弹性成像技术在甲状腺良恶性结节鉴别诊断中的价值。资料与方法回顾性分析手术或穿刺活检病理证实的174例甲状腺结节（232个病灶）患者的临床资料，所有结节分别行灰阶超声及弹性成像检查。计算TI-RADS、超声弹性成像及联合诊断甲状腺良恶性结节的敏感度、特异度、准确度、阳性预测值及阴性预测值。绘制TI-RADS、超声弹性成像及联合诊断甲状腺良恶性结节的受试者工作特征（ROC）曲线，比较ROC曲线下面积。结果超声弹性成像诊断良性结节155个，恶性结节77个，诊断敏感度、特异度及准确度分别为88.9%、91.8%、90.9%；TI-RADS分类诊断良性结节153个，恶性结节79个，诊断敏感度、特异度及准确度分别为76.4%、85.0%、82.3%，弹性成像的敏感度及准确度均高于TI-RADS，差异有统计学意义（χ2=3.920、7.446，P<0.05）；联合诊断诊断良性结节155个，恶性结节77个，敏感度、特异度及准确度分别为93.0%、93.7%、93.5%，均高于单一检查方法（χ2=7.725、6.450、13.728，P<0.05）。弹性成像、TI-RADS及联合诊断的ROC曲线下面积分别为0.833、0.812、0.914，联合诊断准确率高于单一方法，差异有统计学意义（Z=1.95、2.55， P<0.05）。结论与单纯灰阶超声相比，TI-RADS与弹性成像联合应用能够提高甲状腺良恶性结节的诊断敏感度及准确度。%PurposeTo evaluate the value of combined employment of thyroid imaging-reporting and data system (TI-RADS) and ultrasound elastography (UE) in the differentiation of benign and malignant thyroid nodules.Materials and Methods The clinical data of 174 patients with 232 thyroid nodules confirmed surgically or pathologically with puncture biopsy were retrospectively analyzed. All nodules were examined by ultrasound and UE. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TI-RADS, UE and the combination of the two methods were calculated respectively, and the receiver operating characteristic curve (ROC) was drawn to evaluate the value of each of the three methods in differentiating benign and malignant thyroid nodules by comparison of area under curve (AUC).Results The diagnostic sensitivity, specificity and accuracy of UE (number of benign nodules: 155, number of malignant nodules: 77) were 88.9%, 91.8% and 90.9%, respectively; those of TI-RADS (number of benign nodules: 153, number of malignant nodules: 79) were 76.4%, 85.0% and 82.3%, respectively. The values measured by UE were significantly higher than those by TI-RADS (χ2=3.920 and 7.446,P<0.05). The sensitivity, specificity and accuracy measured by the combined use of the two methods (number of benign nodules: 155, number of malignant nodules: 77) were 93.0%, 93.7% and 93.5%, respectively, which were higher than either of the methods, and the difference was statistically significant (χ2=7.725, 6.450 and 13.728,P<0.05). The areas under the curve (AUC) were 0.833 and 0.812 respectively for UE and TI-RADS; the AUC for the combination of the two methods was 0.914, which had significantly higher diagnosis accuracy than that by any single method, and the difference was statistically significant (Z=1.95 and 2.55,P<0.05). Conclusion Compared with gray scale ultrasound, the combination of TI-RADS and UE has higher diagnostic sensitivity and accuracy for excluding malignancy in diagnose of thyroid nodules.