甲状腺影像报告和数据系统与细胞学检查鉴别诊断甲状腺结节的临床研究
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摘要
目的评价甲状腺影像报告和数据系统与甲状腺细针穿刺(FNA)细胞学检查对甲状腺结节良、恶性的诊断价值。方法回顾性分析2016年1月～2017年8月在首都医科大学宣武医院诊断为甲状腺结节患者286例(共311个结节)的临床资料。所有患者均于超声检查后接受外科手术或FNA细胞学检查。根据甲状腺影像报告和数据系统对超声图像进行分类评估,并与术后病理结果对照,评价甲状腺影像报告和数据系统超声分类及FNA细胞学检查的诊断效能。结果 311个甲状腺结节中,经术后病理确诊,包括273个恶性结节及38个良性结节。对照病理结果,甲状腺影像报告和数据系统诊断甲状腺恶性结节的准确度为88. 4%(275/311),敏感度为90. 1%(246/273),特异性为76. 3%(29/38); FNA细胞学检查诊断甲状腺恶性结节的准确度为97. 7%(304/311),敏感度为99. 3%(271/273),特异性为86. 8%,(33/38)。ROC曲线分析显示,两种方法诊断恶性甲状腺结节的曲线下面积(AUC)分别为0. 753、0. 944 (Z=5. 246,P=O. 013)。结论甲状腺影像报告和数据系统对鉴别甲状腺结节良、恶性具有较高的诊断价值,FNA细胞学检查能更加有效地判断甲状腺结节性质。
Objective To evaluate the diagnostic value of thyroid imaging report and data system and thyroid fine needle aspiration( FNA) cytology for benign and malignant thyroid nodules. Methods A retrospective analysis of 311 thyroid nodules in 286 patients diagnosed as thyroid nodules at Xuanwu Hospital of Capital Medical University from January 2014 to August 2017 was carried out. Patients underwent surgical excision or FNA biopsy after thyroid ultrasound was performed. A11 ultrasonograms were graded according to thyroid imaging report and data system diagnosis guideline for thyroid nodule. The diagnostic efficiency of thyroid imaging report and data system and FNA biopsy were evaluated comparing with post operative pathological results. Results Among the 311 thyroid nodules,the pathological diagnosis was confirmed,including 273 malignant nodules and 38 benign nodules. According to pathological results,the accuracy of thyroid imaging report and data system diagnosis of malignant thyroid nodules was 88. 4%( 275/311),sensitivity was 90. 1%( 246/273),specificity was 76. 3%( 29/38). The accuracy of FNA cytological examination for diagnosis of malignant thyroid nodules was 97. 7%( 304/311),sensitivity was 99. 3%( 271/273),specificity was 86. 8%( 33/38). The area under the curve( AUC) of ROC was 0. 753 and 0. 944 for thyroid imaging report and data system and FNA biopsy,respectively( Z = 5. 246,P = 0. 013). Conclusion Thyroid imaging report and data system has high diagnostic value in differential diagnosis of thyroid nodules,while FNA may be more effective in diagnosis of thyroid nodules.
Objective To evaluate the diagnostic value of thyroid imaging report and data system and thyroid fine needle aspiration( FNA) cytology for benign and malignant thyroid nodules. Methods A retrospective analysis of 311 thyroid nodules in 286 patients diagnosed as thyroid nodules at Xuanwu Hospital of Capital Medical University from January 2014 to August 2017 was carried out. Patients underwent surgical excision or FNA biopsy after thyroid ultrasound was performed. A11 ultrasonograms were graded according to thyroid imaging report and data system diagnosis guideline for thyroid nodule. The diagnostic efficiency of thyroid imaging report and data system and FNA biopsy were evaluated comparing with post operative pathological results. Results Among the 311 thyroid nodules,the pathological diagnosis was confirmed,including 273 malignant nodules and 38 benign nodules. According to pathological results,the accuracy of thyroid imaging report and data system diagnosis of malignant thyroid nodules was 88. 4%( 275/311),sensitivity was 90. 1%( 246/273),specificity was 76. 3%( 29/38). The accuracy of FNA cytological examination for diagnosis of malignant thyroid nodules was 97. 7%( 304/311),sensitivity was 99. 3%( 271/273),specificity was 86. 8%( 33/38). The area under the curve( AUC) of ROC was 0. 753 and 0. 944 for thyroid imaging report and data system and FNA biopsy,respectively( Z = 5. 246,P = 0. 013). Conclusion Thyroid imaging report and data system has high diagnostic value in differential diagnosis of thyroid nodules,while FNA may be more effective in diagnosis of thyroid nodules.
引文
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5 谷伟军,赵玲,朱笑笑,等.甲状腺恶性结节超声危险因素探讨-2453例甲状腺结节超声特点分析[J].中华内分泌代谢杂志,2013,29(7):548-552
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8 Gertz RJ,Nikiforov Y,Rehrauer W,et al. Mutation in BRAF and other members of the MAPK pathway in papillary thyroid carcinoma in the pediatric population[J]. Arch Pathol Lab Med,2016,140(2):134-139
9周伟,倪晓枫,詹维伟,等.超声引导下细针穿刺抽吸活检对甲状腺床病灶的应用价值[J].中国介入影像与治疗学,2016,13(5):272-275
10 Wong LQ,Baloch ZW. Analysis of the bethesda system for reporting thyroid cytopathology and similar precursor thyroid cytopathology reporting schemes[J]. Adv Anat Pathol,2012,19:313-319
11 Bongiovanni M,Spitale A,Faquin WC,et al. The Bethesda system for reporting thyroid cytopathology:a meta-analysis[J]. Acta Cytol,2012,56:333-339
12 Williams BA,Bullock MJ,Trites JR,et al. Rates of thyroid malignancy by FNA diagnostic category[J]. J Otolaryngol Head Neck Surg,2013,42:61
13 郝莹,田家玮,刘微,等.改良甲状腺影像学报告及数据系统(TI-RADS)分级诊断甲状腺癌的可行性研究[J].中华超声影像学杂志,2015,24(10):878-881
14 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
15 Park JY,Lee HJ,Jang HW,et al. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma[J]. Thyroid,2009,19(11):1257-1264
16 Kwak JY,Han KH,Yoon JH,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
17章晶,徐辉雄,张一峰,等.甲状腺影像报告和数据系统在甲状腺结节分类中的前瞻性验证[J/CD].中华医学超声杂志:电子版,2014,11(2):167-171
2 Nguyen TQ. Diagnosis and treatment of patients with thyroid cancer[J]. Am Health Drug Benefits,2015,8(1):30-40
3 Ali SZ,Cibas ES. The Bethesda system for reporting thyroid cytopathologyⅡ[J]. Acta Cytol,2016,60(5):397-398
4 Cibas ES,Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology[J]. Thyroid,2017,27(11):1341-1346
5 谷伟军,赵玲,朱笑笑,等.甲状腺恶性结节超声危险因素探讨-2453例甲状腺结节超声特点分析[J].中华内分泌代谢杂志,2013,29(7):548-552
6 陈晶,原韶玲,李强,等.具有可疑超声征象甲状腺良性结节超声与病理对照分析[J].中华超声影像学杂志,2016,24(1):24-27
7 Sung JY,Na DG,Kim KS,et al. Diagnostic accuracy of fine needle aspiration versus core needle biopsy for the diagnosis of thyroid malignancy in a clinical cohort[J]. Eur Radiol,2012,22(7):1564-1572
8 Gertz RJ,Nikiforov Y,Rehrauer W,et al. Mutation in BRAF and other members of the MAPK pathway in papillary thyroid carcinoma in the pediatric population[J]. Arch Pathol Lab Med,2016,140(2):134-139
9周伟,倪晓枫,詹维伟,等.超声引导下细针穿刺抽吸活检对甲状腺床病灶的应用价值[J].中国介入影像与治疗学,2016,13(5):272-275
10 Wong LQ,Baloch ZW. Analysis of the bethesda system for reporting thyroid cytopathology and similar precursor thyroid cytopathology reporting schemes[J]. Adv Anat Pathol,2012,19:313-319
11 Bongiovanni M,Spitale A,Faquin WC,et al. The Bethesda system for reporting thyroid cytopathology:a meta-analysis[J]. Acta Cytol,2012,56:333-339
12 Williams BA,Bullock MJ,Trites JR,et al. Rates of thyroid malignancy by FNA diagnostic category[J]. J Otolaryngol Head Neck Surg,2013,42:61
13 郝莹,田家玮,刘微,等.改良甲状腺影像学报告及数据系统(TI-RADS)分级诊断甲状腺癌的可行性研究[J].中华超声影像学杂志,2015,24(10):878-881
14 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
15 Park JY,Lee HJ,Jang HW,et al. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma[J]. Thyroid,2009,19(11):1257-1264
16 Kwak JY,Han KH,Yoon JH,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
17章晶,徐辉雄,张一峰,等.甲状腺影像报告和数据系统在甲状腺结节分类中的前瞻性验证[J/CD].中华医学超声杂志:电子版,2014,11(2):167-171