超声弹性成像对甲状腺良恶性结节的诊断价值
|
摘要
目的探讨超声弹性成像技术(UE)对甲状腺癌的诊断价值,分析超声弹性成像参数[应变率比值(SR)、弹性评分]与甲状腺良恶性结节病理特征的相关性。方法选择2015年1月至2017年1月我院收治的184例甲状腺结节患者为研究对象,所有患者均行UE检查,并经组织活检或病理证实。对比良恶性甲状腺结节弹性评分、SR差异,Pearson相关性分析弹性评分、SR与甲状腺良恶性结节相关增殖基因[叉头盒蛋白A1(FOXA1)、表没食子儿茶素没食子酸酯(EGCG)、程序性细胞死亡基因4(PDCD4)、Yes相关蛋白(YAP)、TPX2)]的相关性,受试者工作特征曲线(ROC)分析弹性评分、SR对甲状腺癌诊断价值。结果本组72例患者为恶性甲状腺结节(恶性组),112例为良性甲状腺结节(良性组),良性组甲状腺结节弹性评分、SR值均低于恶性组(P <0.05),恶性组FOXA1、YAP、TPX2 mRNA表达高于良性组(P <0.05),EGCG、PDCD4 mRNA表达低于良性组(P <0.05)。弹性评分、SR值与FOXA1、YAP、TPX2 mRNA表达量呈正相关(r=0.437～0.695,P <0.05),与EGCG、PDCD4 mRNA表达量呈负相关(r=-0.357～-0.664,P <0.05)。ROC分析显示弹性评分、SR值诊断甲状腺癌的曲线下面积(AUC)分别为0.808(95%CI:0.699～0.917,P=0.000)、0.869(95%CI:0.765～0.973,P=0.001),当弹性评分> 2.59分时,弹性评分诊断甲状腺癌的灵敏度和特异度分别为88.89%、88.52%,当SR值> 3.02时,SR值诊断甲状腺癌的灵敏度和特异度分别为90.28%、90.16%。结论 UE参数在良恶性甲状腺结节中存在明显差异,且与甲状腺良恶性结节相关增殖基因表达存在明显相关性。UE可作为无创诊断甲状腺癌的检测方法。
Objective To explore the diagnostic value of ultrasound elastography(UE)in thyroid carcinoma,and to analyze the correlation between ultrasound elastography parameters[the strain rate(SR)and elasticscore]and the pathological features of benign and malignant thyroid nodules. Methods A total of 184 patientswith thyroid nodules admitted to our hospital from January 2015 to January 2017 were selected as subjects. Allpatients underwent UE examination and were confirmed by tissue biopsy or pathology. The elastic score and SR difference of benign and malignant thyroid nodules were compared. The correlation between elasticity score,SR andbenign and malignant thyroid nodules-related proliferative genes[forkhead box protein A(FOXA1),epigallocatechin gallate(EGCG),programmed cell death gene 4(PDCD4),yes-associated protein(YAP),TPX2]was analyzed by Pearson correlation analysis. The diagnostic value of elastic score and SR in thyroid carcinoma was analyzed by receiver operator characteristic curve(ROC). Results 72 cases were malignant thyroid nodules(malig-nant group)and 112 cases were benign thyroid nodules(benign group).The elastic score and SR values of thyroidnodules in the benign group were all lower than those in the malignant group(P < 0.05). The elastic score and SRvalues were positively correlated with FOXA1,YAP and TPX2 mRNA expression(r = 0.437 ～ 0.695,P < 0.05),and negatively correlated with EGCG and PDCD4 mRNA expression(r =-0.357 ～-0.664,P < 0.05). ROC analysisshowed that the area under the curve(AUC)of elastic score and SR value for thyroid cancer diagnosis were 0.808(95% CI:0.699 ～ 0.917,P < 0.001),0.869(95% CI:0.765 ～ 0.973,P < 0.001)respectively. When the elasticscore was greater than 2.59,the sensitivity and specificity of the elastic score for thyroid cancer diagnosis were88.89% and 88.52% respectively,and when SR value was greater than 3.02,the sensitivity and specificity of SRvalue for thyroid cancer diagnosis were 90.28% and 90.16% respectively. Conclusion UE parameters are significantly different in benign and malignant thyroid nodules,and are significantly correlated with the expression of proliferative genes related to benign and malignant thyroid nodules. UE can be used as a noninvasive diagnostic method for thyroid cancer.
Objective To explore the diagnostic value of ultrasound elastography(UE)in thyroid carcinoma,and to analyze the correlation between ultrasound elastography parameters[the strain rate(SR)and elasticscore]and the pathological features of benign and malignant thyroid nodules. Methods A total of 184 patientswith thyroid nodules admitted to our hospital from January 2015 to January 2017 were selected as subjects. Allpatients underwent UE examination and were confirmed by tissue biopsy or pathology. The elastic score and SR difference of benign and malignant thyroid nodules were compared. The correlation between elasticity score,SR andbenign and malignant thyroid nodules-related proliferative genes[forkhead box protein A(FOXA1),epigallocatechin gallate(EGCG),programmed cell death gene 4(PDCD4),yes-associated protein(YAP),TPX2]was analyzed by Pearson correlation analysis. The diagnostic value of elastic score and SR in thyroid carcinoma was analyzed by receiver operator characteristic curve(ROC). Results 72 cases were malignant thyroid nodules(malig-nant group)and 112 cases were benign thyroid nodules(benign group).The elastic score and SR values of thyroidnodules in the benign group were all lower than those in the malignant group(P < 0.05). The elastic score and SRvalues were positively correlated with FOXA1,YAP and TPX2 mRNA expression(r = 0.437 ～ 0.695,P < 0.05),and negatively correlated with EGCG and PDCD4 mRNA expression(r =-0.357 ～-0.664,P < 0.05). ROC analysisshowed that the area under the curve(AUC)of elastic score and SR value for thyroid cancer diagnosis were 0.808(95% CI:0.699 ～ 0.917,P < 0.001),0.869(95% CI:0.765 ～ 0.973,P < 0.001)respectively. When the elasticscore was greater than 2.59,the sensitivity and specificity of the elastic score for thyroid cancer diagnosis were88.89% and 88.52% respectively,and when SR value was greater than 3.02,the sensitivity and specificity of SRvalue for thyroid cancer diagnosis were 90.28% and 90.16% respectively. Conclusion UE parameters are significantly different in benign and malignant thyroid nodules,and are significantly correlated with the expression of proliferative genes related to benign and malignant thyroid nodules. UE can be used as a noninvasive diagnostic method for thyroid cancer.
引文
[1]李振红,赖胜坤,史妙丽,等.超声弹性成像对Ⅱ型甲状腺结节的鉴别能力分析[J].泰山医学院学报,2018,39(12):1385-1387.
[2]TAMHANE S,GHARIB H.Thyroid nodule update on diagnosis and management[J].Clin Diabetes Endocrinol,2016,2:17.
[3]STACHS A,PANDJAITAN A,MARTIN A,et al.Accuracy of tumor sizing in breast cancer:a comparison of strain elastography,3-d ultrasound and conventional b-mode ultrasound with and without compound imaging[J].Ultrasound Med Biol,2016,42(12):2758-2765.
[4]YEOSH,KIM G R,LEE S H,et al.Comparison of ultrasound elastography and color doppler ultrasonography for distinguishing small triple-negative breast cancer from fibroadenoma:elastography and us for triple-negative breast cancer versus fibroadenoma[J].J Ultrasound Med,2018,37(9):2135-2146.
[5]CANTISANI V,MACETONI P,D.ANEREA V,et al.Strain ratio ultrasound elastography increases the accuracy of colour-Doppler ultrasound in the evaluation of Thy-3 nodules.A bi-centre university experience[J].European Radiology,2016,26(5):1441-1449.
[6]KOH J,MOON H J,PARK J S,et al.Variability in interpretation of ultrasound elastography and gray-scale ultrasound in assessing thyroid nodules[J].Ultrasound Med Biol,2016,42(1):51-59.
[7]WANG X L,TAO L,ZHOU X L,et al.Initial experience of automated breast volume scanning(ABVS)and ultrasound elastography in predicting breast cancer subtypes and staging[J].Breast,2016,30:130-135.
[8]WANG Y,YAO B,LI H,et al.Assessment of tumor stiffness with shear wave elastography in a human prostate cancer xenograft implantation model[J].J Ultrasound Med,2017,36(5):955-963.
[9]JIN X Z,LU W W,ZHANG H F,et al.Comparative study on the diagnostic values of different ultrasound technologies for malignant thyroid nodules[J].Oncol Lett,2018,16(1):910-914.
[10]RAGO T,SCUTARI M,LOIACONO V,et al.Low elasticity of thyroid nodules at ultrasound elastography is correlated with malignancy,degree of fibrosis and high expression of galectin-3and fibronectin-1[J].Thyroid,2017,27(1):103-110.
[11]XU Y,QIN L,SUN T,et al.Twist1 promotes breast cancer invasion and metastasis by silencing foxa1 expression[J].Oncogene,2017,36(8):1157-1166.
[12]殷月玲,于晓东.甲状腺癌细针穿刺组织中S100A13、FOXA1表达量与细胞周期、细胞侵袭的相关性[J].海南医学院院报,2018,24(01):71-74.
[13]刘晓辉,丁丽娟.EGCG诱导甲状腺乳头状癌细胞凋亡及对Survivin蛋白表达的影响[J].肿瘤基础与临床,2009,22(1):27-29.
[14]LUO K W,LUNG W Y,CHUN-XIE,et al.EGCG inhibited bladder cancer T24 and 5637cell proliferation and migration via PI3K/AKT pathway[J].Oncotarget,2018,9(15):12261-12272.
[15]FUJIKI H,WATANABE T,SUEOKA E,et al.Cancer prevention with green tea and its principal constituent,EGCG:from early investigations to current focus on human cancer stem cells[J].Mol Cells,2018,41(2):73-82.
[16]谢茂云,黄耀,杨莉涛,等.PDCD4对甲状腺癌SW579细胞调亡及成瘤能力的影响[J].海南医学,2016,27(23):3790-3793.
[17]TAN G,CAO X,DAI Q,et al.A novel role for microRNA-129-5p in inhibiting ovarian cancer cell proliferation and survival via direct suppression of transcriptional co-activators YAP and TAZ[J].Oncotarget,2015,6(11):8676-8686.
[18]章杰,林义,林雅,等.YAP在人甲状腺乳头状癌中的表达及对细胞生长的影响[J].重庆医学,2016,45(12):1653-1655.
[19]YAN L,LI Q,YANG J,et al.TPX2-p53-GLIP1 regulatory circuitry in cell proliferation,invasion,and tumor growth of bladder cancer[J].J Cell Biochem,2018,119(2):1791-1803.
[20]关善斌,黄新若,李加伟,等.TPX2在甲状腺乳头状癌中的表达及其对甲状腺癌KAT细胞增殖能力的影响[J].广东药科大学学报,2017,33(4):551-555.
[2]TAMHANE S,GHARIB H.Thyroid nodule update on diagnosis and management[J].Clin Diabetes Endocrinol,2016,2:17.
[3]STACHS A,PANDJAITAN A,MARTIN A,et al.Accuracy of tumor sizing in breast cancer:a comparison of strain elastography,3-d ultrasound and conventional b-mode ultrasound with and without compound imaging[J].Ultrasound Med Biol,2016,42(12):2758-2765.
[4]YEOSH,KIM G R,LEE S H,et al.Comparison of ultrasound elastography and color doppler ultrasonography for distinguishing small triple-negative breast cancer from fibroadenoma:elastography and us for triple-negative breast cancer versus fibroadenoma[J].J Ultrasound Med,2018,37(9):2135-2146.
[5]CANTISANI V,MACETONI P,D.ANEREA V,et al.Strain ratio ultrasound elastography increases the accuracy of colour-Doppler ultrasound in the evaluation of Thy-3 nodules.A bi-centre university experience[J].European Radiology,2016,26(5):1441-1449.
[6]KOH J,MOON H J,PARK J S,et al.Variability in interpretation of ultrasound elastography and gray-scale ultrasound in assessing thyroid nodules[J].Ultrasound Med Biol,2016,42(1):51-59.
[7]WANG X L,TAO L,ZHOU X L,et al.Initial experience of automated breast volume scanning(ABVS)and ultrasound elastography in predicting breast cancer subtypes and staging[J].Breast,2016,30:130-135.
[8]WANG Y,YAO B,LI H,et al.Assessment of tumor stiffness with shear wave elastography in a human prostate cancer xenograft implantation model[J].J Ultrasound Med,2017,36(5):955-963.
[9]JIN X Z,LU W W,ZHANG H F,et al.Comparative study on the diagnostic values of different ultrasound technologies for malignant thyroid nodules[J].Oncol Lett,2018,16(1):910-914.
[10]RAGO T,SCUTARI M,LOIACONO V,et al.Low elasticity of thyroid nodules at ultrasound elastography is correlated with malignancy,degree of fibrosis and high expression of galectin-3and fibronectin-1[J].Thyroid,2017,27(1):103-110.
[11]XU Y,QIN L,SUN T,et al.Twist1 promotes breast cancer invasion and metastasis by silencing foxa1 expression[J].Oncogene,2017,36(8):1157-1166.
[12]殷月玲,于晓东.甲状腺癌细针穿刺组织中S100A13、FOXA1表达量与细胞周期、细胞侵袭的相关性[J].海南医学院院报,2018,24(01):71-74.
[13]刘晓辉,丁丽娟.EGCG诱导甲状腺乳头状癌细胞凋亡及对Survivin蛋白表达的影响[J].肿瘤基础与临床,2009,22(1):27-29.
[14]LUO K W,LUNG W Y,CHUN-XIE,et al.EGCG inhibited bladder cancer T24 and 5637cell proliferation and migration via PI3K/AKT pathway[J].Oncotarget,2018,9(15):12261-12272.
[15]FUJIKI H,WATANABE T,SUEOKA E,et al.Cancer prevention with green tea and its principal constituent,EGCG:from early investigations to current focus on human cancer stem cells[J].Mol Cells,2018,41(2):73-82.
[16]谢茂云,黄耀,杨莉涛,等.PDCD4对甲状腺癌SW579细胞调亡及成瘤能力的影响[J].海南医学,2016,27(23):3790-3793.
[17]TAN G,CAO X,DAI Q,et al.A novel role for microRNA-129-5p in inhibiting ovarian cancer cell proliferation and survival via direct suppression of transcriptional co-activators YAP and TAZ[J].Oncotarget,2015,6(11):8676-8686.
[18]章杰,林义,林雅,等.YAP在人甲状腺乳头状癌中的表达及对细胞生长的影响[J].重庆医学,2016,45(12):1653-1655.
[19]YAN L,LI Q,YANG J,et al.TPX2-p53-GLIP1 regulatory circuitry in cell proliferation,invasion,and tumor growth of bladder cancer[J].J Cell Biochem,2018,119(2):1791-1803.
[20]关善斌,黄新若,李加伟,等.TPX2在甲状腺乳头状癌中的表达及其对甲状腺癌KAT细胞增殖能力的影响[J].广东药科大学学报,2017,33(4):551-555.