超声量化评分系统联合细针穿刺鉴别诊断甲状腺结节的临床分析
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摘要
目的探讨甲状腺超声量化评分系统联合超声引导下细针穿刺在鉴别甲状腺结节良恶性中的临床应用价值。方法回顾性分析2015年10月至2017年6月我院内分泌科收治的接受超声引导下细针穿刺且手术病理证实的100例甲状腺结节患者的超声声像图,分别对常规灰阶超声及多普勒超声显示的结节形状、回声强度、生长形状、钙化灶、光晕、回声结构、直径、边界、增长速度、颈部淋巴结等10项超声特征,按照超声量化评分表予以评分;超声引导下细针穿刺的细胞学结果采用贝塞斯达系统(Bethesda System)予以分级,以手术后病理结果为金标准,分别绘制超声量化评分系统、超声引导下细针穿刺及二者联合ROC曲线,比较三者的诊断价值。结果共纳入100例甲状腺结节患者,年龄20～73岁(45.29±11.70)岁,其中男性15例,女性85例。促甲状腺激素(thyroid stimulating hormone TSH)高于正常值的11例、低于正常值的5例、在正常范围内84例。超声量化评分系统、超声引导下细针穿刺及二者联合的ROC曲线下面积分别为0.783、0.740、0. 844。超声量化评分系统的最佳评分切点是2,即>2分诊断为恶性,<2分诊断为良性。诊断效能的灵敏度为84. 37%,特异度为55. 56%,阳性预测率为77.14%,阴性预测率为66. 67%。细针穿刺的最佳分类切点是3,即细胞学分级Ⅰ、Ⅱ、Ⅲ级为良性,Ⅳ、Ⅴ、Ⅵ级为恶性,诊断效能的敏感度为79.69%,特异度为61.11%,阳性预测率为78.46%,阴性预测率为62.86%。二者联合的诊断效能的敏感度为85.94%,特异度为77.78%,阳性预测率为87. 30%,阴性预测率为75.68%。结论超声量化评分系统联合细针穿刺对甲状腺结节良恶性的诊断效能高于单一一种诊断方法。超声量化评分和细针穿刺分级对甲状腺结节良恶性的联合诊断回归方程为Logit(P)=0.797×超声评分+0.600×细针穿刺分级-3.746,以0.4为截断点能获得最大的诊断效能。
Objective To explore the clinical value of ultrasonic quantification system in combination with ultrasound-guided fine needle aspiration biopsy( US-FNAB) in the differential diagnosis of benign and malignant thyroid nodules. Methods The ultrasonographic features of 100 patients with thyroid nodules and undergoing US-FNAB in our department from October 2015 to June 2017 were collected and retrospectively analyzed. Ten sonographic features including nodular shape, echo intensity, growth shape,calcifications, halo, echo structure, diameter, boundary, growth rate and neck lymph nodes by conventional gray-scale ultrasound and Doppler ultrasound examinations were analyzed and scored with ultrasonic quantification system. The cytological results of US-FNAB were graded with Bethesda system. The postoperative pathological results were regarded as gold standard. The receiver operating characteristic(ROC)curve of ultrasonic quantification system, US-FNAB and their combination were draw respectively to compare the diagnostic values of the 3 methods. Results The 100 subjected patients were 15 males and 85 females and at a mean age of 45. 29 ± 11. 70(20 ～73) years. There were 11 cases with thyroid stimulating hormone(TSH) higher than normal value, 5 cases lower and 84 cases within the normal range. The area under ROC curve was 0.783, 0.740 and 0.844, respectively for the ultrasonic quantitation system, US-FNAB and their combination. The best cutoff point of ultrasonic quantitation system was 2, that is, the nodules of > 2 points were diagnosed as malignant, while <2 points were diagnosed as benign. The sensitivity, specificity, positive predictive value and negative predictive value of the quantitation system was 84. 37%, 55.56%, 77. 14% and 66. 67%. The best cutoff point of o US-FNAB was 3, indicating the nodules of cytological classification I,Ⅱ and Ⅲ as benign, while of Ⅳ, Ⅴ and Ⅵ as malignant. The sensitivity, specificity, positive predictive value and negative predictive value was 79. 69 %, 61.11%, 78. 46% and 62. 86%, respectively, while was 85. 94%,77. 78%,87. 30% and 75. 68%,respectively when combined together. Conclusion The diagnostic efficacy of ultrasonic quantitation system combined with US-FNAB is superior to either one of them for diagnosis of benign and malignant thyroid nodules. The Logit regression equation of the combination is(P)=0.797 × ultrasonic score +0.600 × fine needle aspiration biopsy classification-3.746, with 0.4 as the cut-off point to achieve maximal efficiency for diagnosis.
Objective To explore the clinical value of ultrasonic quantification system in combination with ultrasound-guided fine needle aspiration biopsy( US-FNAB) in the differential diagnosis of benign and malignant thyroid nodules. Methods The ultrasonographic features of 100 patients with thyroid nodules and undergoing US-FNAB in our department from October 2015 to June 2017 were collected and retrospectively analyzed. Ten sonographic features including nodular shape, echo intensity, growth shape,calcifications, halo, echo structure, diameter, boundary, growth rate and neck lymph nodes by conventional gray-scale ultrasound and Doppler ultrasound examinations were analyzed and scored with ultrasonic quantification system. The cytological results of US-FNAB were graded with Bethesda system. The postoperative pathological results were regarded as gold standard. The receiver operating characteristic(ROC)curve of ultrasonic quantification system, US-FNAB and their combination were draw respectively to compare the diagnostic values of the 3 methods. Results The 100 subjected patients were 15 males and 85 females and at a mean age of 45. 29 ± 11. 70(20 ～73) years. There were 11 cases with thyroid stimulating hormone(TSH) higher than normal value, 5 cases lower and 84 cases within the normal range. The area under ROC curve was 0.783, 0.740 and 0.844, respectively for the ultrasonic quantitation system, US-FNAB and their combination. The best cutoff point of ultrasonic quantitation system was 2, that is, the nodules of > 2 points were diagnosed as malignant, while <2 points were diagnosed as benign. The sensitivity, specificity, positive predictive value and negative predictive value of the quantitation system was 84. 37%, 55.56%, 77. 14% and 66. 67%. The best cutoff point of o US-FNAB was 3, indicating the nodules of cytological classification I,Ⅱ and Ⅲ as benign, while of Ⅳ, Ⅴ and Ⅵ as malignant. The sensitivity, specificity, positive predictive value and negative predictive value was 79. 69 %, 61.11%, 78. 46% and 62. 86%, respectively, while was 85. 94%,77. 78%,87. 30% and 75. 68%,respectively when combined together. Conclusion The diagnostic efficacy of ultrasonic quantitation system combined with US-FNAB is superior to either one of them for diagnosis of benign and malignant thyroid nodules. The Logit regression equation of the combination is(P)=0.797 × ultrasonic score +0.600 × fine needle aspiration biopsy classification-3.746, with 0.4 as the cut-off point to achieve maximal efficiency for diagnosis.
引文
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[2]陈晓康,陈少华,吕国荣.超声TI-RADS分类对甲状腺结节的诊断价值[J].中国超声医学杂志,2012,28(12):1066-1068.CHEN X K,CHEN S H,LV G R. The applicational value of TI-RADS ultrasonographic stratification in diagnosing thyroid nodules[J]. Chin J Ultrasound Med,2012,28(12):1066-1068.
[3] ADAMCZEWSKI Z, LEWINSKI A. Proposed algorithm for management of patients with thyroid nodules/focal lesions,based on ultrasound(US)and fine-needle aspiration biopsy(FNAB); our own experience[J]. Thyroid Res,2013,6:6.DOI:10.1186/1756-6614-6-6.
[4] CIBAS E S,ALI S Z. The Bethesda system for reporting thyroid cytopathology[J]. Thyroid, 2009, 19(11):1159-1165. DOI:10.1089/thy. 2009.0274.
[5]杨英,魏枫,薛晔霞.甲状腺结节细针穿刺细胞学检查与TI-RADS的价值分析[J].中华临床医师杂志(电子版),2016,10(17):2547-2551.YANG Y,WEI F,XUE Y X. Fine needle aspiration cytology and TI-RADS evaluation in thyroid nodules[J]. Chin J Clinicians(Electr Ed),2016,10(17):2547-2551.
[6]王深明,李梓伦.重视甲状腺结节的正确评估和随访[J].中国实用外科杂志,2010(s1):824-827.WANG S M, LI Z L. Attach importance to the appropriate evaluation and follow-up of thyroid nodules[J]. Chin J Prac Surg,2010(s1):824-827.
[7] KWAK J Y,HAN K H,YOON J H,et al. Thyroid imaging reporting and data system for US features of nodules:a step in establishing better stratification of cancer risk[J]. Radiology,2011,260(3):892-899. DOI:10.1148/radiol. 11110206.
[8]周伟,宋琳琳,徐上妍,等.超声引导下甲状腺结节细针穿刺及量化分级系统的临床价值[J].医学影像学杂志,2014(7):1131-1134.ZHOU W, SONG L L, XU S Y,et al. Value of quantitative grading system of ultrasonography and ultrasound-guided fine needle aspiration biopsy in thyroid nodules[J]. J Med Imaging,2014(7):1131-1134.
[9] HORVATH E, MAJLIS S, ROSSI R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management[J]. J Clin Endocrinol Metab,2009, 94(5):1748-1751. DOI:10.1210/jc.2008-1724.
[10] KWAK J Y, KIM E K, KIM H J, et al. How to combine ultrasound and cytological information in decision making about thyroid nodules[J]. Eur Radiol,2009,19(8):1923-1931. DOI:10.1007/s00330-009-1369-7.
[11]唐鹤文,张波,姜玉新.超声引导下甲状腺结节细针穿刺活检进展[J].中国实用外科杂志,2015,35(6):679-683.TANG H W,ZHANG B, JIANG Y X. Progress of fine needle aspiration biopsy of thyroid nodules guided by ultrasound[J]. Chin J Prac Surg, 2015, 35(6):679-683.
[12]高秋霞,张明礼,程艳,等.超声引导下甲状腺结节细针穿刺细胞学检查的应用现状[J].肿瘤学杂志,2016,22(10):856-860.GAO Q X, ZHANG M L, CHENG Y, et al. Application of ultrasound-guided fine-needle aspiration cytology in diagnosis of thyroid nodules[J]. J Chin Oncol,2016,22(10):856-860.
[13]杨帆,郭美金,吴斌,等.甲状腺微小癌的超声表现及其诊断[J].中国医学影像学杂志,2009,17(4):310-312.YANG F,GUO M J,WU B,et al. Ultrasound findings and diagnosis of thyroid microcarcinoma[J]. Chin J Med Imaging,2009,17(4):310-312.
[14]黄崑,刘艳君,赵一,等.量化评分鉴别诊断甲状腺结节良恶性的价值[J].中华医学超声杂志(电子版),2014(10):836-839.HUANG K,LIU Y J,Zhao Y,et al. The value of quantitive scoring method in differential diagnosis of thyroid nodules[J]. Chin J Med Ultrasound(Electr Ed),2014(10):836-839.
[15]GHARIB H, PAPINI E, PASCHKE R. et al. American association of clinical endocrinologists,associazione medici endocrinology,and European thyroid association medical guideline for clinical practice for the diagnosis and management of thyroid nodules[J]. Endocr Prac,2010,16:1-43.
[2]陈晓康,陈少华,吕国荣.超声TI-RADS分类对甲状腺结节的诊断价值[J].中国超声医学杂志,2012,28(12):1066-1068.CHEN X K,CHEN S H,LV G R. The applicational value of TI-RADS ultrasonographic stratification in diagnosing thyroid nodules[J]. Chin J Ultrasound Med,2012,28(12):1066-1068.
[3] ADAMCZEWSKI Z, LEWINSKI A. Proposed algorithm for management of patients with thyroid nodules/focal lesions,based on ultrasound(US)and fine-needle aspiration biopsy(FNAB); our own experience[J]. Thyroid Res,2013,6:6.DOI:10.1186/1756-6614-6-6.
[4] CIBAS E S,ALI S Z. The Bethesda system for reporting thyroid cytopathology[J]. Thyroid, 2009, 19(11):1159-1165. DOI:10.1089/thy. 2009.0274.
[5]杨英,魏枫,薛晔霞.甲状腺结节细针穿刺细胞学检查与TI-RADS的价值分析[J].中华临床医师杂志(电子版),2016,10(17):2547-2551.YANG Y,WEI F,XUE Y X. Fine needle aspiration cytology and TI-RADS evaluation in thyroid nodules[J]. Chin J Clinicians(Electr Ed),2016,10(17):2547-2551.
[6]王深明,李梓伦.重视甲状腺结节的正确评估和随访[J].中国实用外科杂志,2010(s1):824-827.WANG S M, LI Z L. Attach importance to the appropriate evaluation and follow-up of thyroid nodules[J]. Chin J Prac Surg,2010(s1):824-827.
[7] KWAK J Y,HAN K H,YOON J H,et al. Thyroid imaging reporting and data system for US features of nodules:a step in establishing better stratification of cancer risk[J]. Radiology,2011,260(3):892-899. DOI:10.1148/radiol. 11110206.
[8]周伟,宋琳琳,徐上妍,等.超声引导下甲状腺结节细针穿刺及量化分级系统的临床价值[J].医学影像学杂志,2014(7):1131-1134.ZHOU W, SONG L L, XU S Y,et al. Value of quantitative grading system of ultrasonography and ultrasound-guided fine needle aspiration biopsy in thyroid nodules[J]. J Med Imaging,2014(7):1131-1134.
[9] HORVATH E, MAJLIS S, ROSSI R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management[J]. J Clin Endocrinol Metab,2009, 94(5):1748-1751. DOI:10.1210/jc.2008-1724.
[10] KWAK J Y, KIM E K, KIM H J, et al. How to combine ultrasound and cytological information in decision making about thyroid nodules[J]. Eur Radiol,2009,19(8):1923-1931. DOI:10.1007/s00330-009-1369-7.
[11]唐鹤文,张波,姜玉新.超声引导下甲状腺结节细针穿刺活检进展[J].中国实用外科杂志,2015,35(6):679-683.TANG H W,ZHANG B, JIANG Y X. Progress of fine needle aspiration biopsy of thyroid nodules guided by ultrasound[J]. Chin J Prac Surg, 2015, 35(6):679-683.
[12]高秋霞,张明礼,程艳,等.超声引导下甲状腺结节细针穿刺细胞学检查的应用现状[J].肿瘤学杂志,2016,22(10):856-860.GAO Q X, ZHANG M L, CHENG Y, et al. Application of ultrasound-guided fine-needle aspiration cytology in diagnosis of thyroid nodules[J]. J Chin Oncol,2016,22(10):856-860.
[13]杨帆,郭美金,吴斌,等.甲状腺微小癌的超声表现及其诊断[J].中国医学影像学杂志,2009,17(4):310-312.YANG F,GUO M J,WU B,et al. Ultrasound findings and diagnosis of thyroid microcarcinoma[J]. Chin J Med Imaging,2009,17(4):310-312.
[14]黄崑,刘艳君,赵一,等.量化评分鉴别诊断甲状腺结节良恶性的价值[J].中华医学超声杂志(电子版),2014(10):836-839.HUANG K,LIU Y J,Zhao Y,et al. The value of quantitive scoring method in differential diagnosis of thyroid nodules[J]. Chin J Med Ultrasound(Electr Ed),2014(10):836-839.
[15]GHARIB H, PAPINI E, PASCHKE R. et al. American association of clinical endocrinologists,associazione medici endocrinology,and European thyroid association medical guideline for clinical practice for the diagnosis and management of thyroid nodules[J]. Endocr Prac,2010,16:1-43.