多种超声征象联合对直径>1.0cm甲状腺乳头状癌的预测价值

摘要

Objective To discuss the predictive value of multiple ultrasonic features combination in diagnosis of thyroid papillary carcinoma (PTC) more than 1.0 cm in diameter. Methods The ultrasonic features of 258 PTC nodules from 251 patients and 207 nodular goiter (NG) nodules from 190 patients in the First People′s Hospital of Hangzhou were retrospectively analyzed. All the nodules were confirmed by pathological examination after surgery. The ultrasonic features included the shape of nodules, internal echo,anteroposterior/transverse diameter ratio (A/T), and microcalcification. The χ2 test was used to analyze the differences of ultrasonic features between PTC and NG. Multi-variate analyses (Logistic regression) was used to analyze the predictive risk ultrasonic features of PTC. The sensitivity and specificity of ultrasonic features were analyzed based on the gold standard of pathological results. Results There were significantly differences between 258 PTC nodules and 207 NG nodules in irregular shape, hypoechogenicity,A/T > 1 and microcalcification (χ2 values were 121.511, 105.411, 41.483, 121.072, all P < 0.01). The results of Logistic regression showed that irregular shape, hypoechogenicity, A/T>1 and microcalcification were risk ultrasonic features of PTC. And their OR values were 5.013 (95%CI 2.919-8.610), 5.811 (95%CI 3.411-9.901), 15.399 (95%CI 7.576-31.301), 4.141 (95%CI 1.687-10.164) respectively. The sensitivity and specificity of single ultrasonic feature were 26.0%-79.5% and 71.5%-96.1%; the sensitivity and specificity of two ultrasonographic features combination were 11.2%-57.0% and 92.3%-99.0%; and the sensitivity and specificity of three or four ultrasonographic features combination were 8.1%-31.8% and 99.0%-99.5%.Conclusions Irregular shape, hypoechogenicity, A/T> 1 and microcalcification of thyroid neoplasm are important ultrasonic features of PTC. Although the sensitivity of single ultrasonic feature in diagnosing PTC is higher than that of multiple features combination, it has a lower specificity. Therefore, combination of multiple ultrasonographic features can improve the specificity in diagnosing PTC and reduce the misdiagnosis of PTC.%目的 探讨多种超声征象联合对直径>1.0 cm甲状腺乳头状癌(PTC)的预测价值.方法 回顾性分析2013年1月至2014年12月杭州市第一人民医院收治的并经手术病理证实且直径>1.0 cm的251例258枚PTC和190例207枚结节性甲状腺肿(NG)的超声表现,包括瘤体形态、内部回声、纵横比(A/T)及微钙化,采用χ2检验比较PTC与NG超声征象差异;采用多因素Logistic回归分析筛选PTC的危险超声征象;以手术病理结果作为金标准,计算超声征象诊断PTC的敏感度和特异度.结果 本组258枚PTC和207枚NG形态、内部回声、A/T和微钙化等超声征象差异均有统计学意义(χ2值分别为121.511、105.411、41.483、121.072,P均<0.01).Logistic回归分析结果显示,瘤体形态不规则、内部低回声、A/T>1和微钙化是PTC的危险超声征象,其OR值分别为5.013(95%CI 2.919~8.610)、5.811(95%CI 3.411~9.901)、15.399(95%CI 7.576~31.301)、4.141(95%CI 1.687~10.164).单一超声征象诊断PTC的敏感度和特异度分别为26.0%~79.5%和71.5%~96.1%,2种超声征象组合诊断PTC的敏感度和特异度分别为11.2%~57.0%和92.3%~99.0%,3种或4种超声征象组合诊断PTC的敏感度和特异度分别为8.1%~31.8%和99.0%~99.5%.结论 瘤体形态不规则、内部低回声、A/T>1和微钙化是PTC的重要超声征象.尽管单一超声征象诊断PTC的敏感度较高,但特异度较低,而多种超声征象联合可明显提高诊断PTC的特异度,从而降低PTC误诊的发生.