摘要
目的探讨超声弹性指数比值法与指数法在甲状腺良、恶性结节鉴别诊断中的应用价值。方法收集2015年1月至2016年1月在哈尔滨医科大学附属第四医学院因甲状腺结节住院手术患者的临床检查资料，进行回顾性分析。采用弹性指数比值法与弹性指数法，依据约登指数的最佳诊断临界点对甲状腺良、恶性结节分别进行诊断。并与病理诊断结果进行比较。按结节最大长径分组：〈1、1-2、〉2cm组，采用上述两种方法对大小不同的甲状腺良、恶性结节进行敏感度、特异度、准确度分析，并绘制受试者工作特征曲线（ROC）。结果共收集甲状腺结节手术患者90例（108个结节），其中男性28例，女性62例，平均年龄（44．1±11．5）岁，范围为20-69岁。病理诊断为良性结节70个，恶性结节38个。超声弹性指数比值法共诊断良性结节63个、恶性结节45个，与病理诊断结果比较，恶性结节误诊13个，漏诊6个。超声弹性指数法共诊断良性结节63个、恶性结节45个，与病理诊断结果比较，恶性结节误诊16个，漏诊9个。弹性指数比值法诊断甲状腺良、恶性结节，与病理诊断结果比较，〈1、1-2、〉2cm组的诊断敏感度分别为91．7％、86．0％、75．0％，特异度分别为88．9％、78．6％、79．2％，准确度分别为90．0％、81．0％、77．8％，组间敏感度、准确度比较差异有统计学意义（χ^2=76．4、70．8，P均〈0．05）。弹性指数法诊断甲状腺良、恶性结节，与病理诊断结果比较，〈1、1-2、〉2cm组的诊断敏感度分别为83-3％、78．6％、66．7％，特异度分别为83-3％、75．0％、75．0％，准确度分别为83．3％、76．0％、72．2％，组间敏感度、准确度比较差异有统计学意义（χ^2=82．8、74．5，P均〈0．05）。弹性指数比值法ROC曲线下面积为0．814，弹性指数法ROC曲线下面积为0．766，二者曲线下面积比较差异有统计学意义（Z=0．896，P〈0．05）。结论在不同大小甲状腺结节良、恶性鉴别诊断中．弹性指数比值法优于弹性指数法．结节≤2cm的诊断价佰更高．
Objective To explore the application value of ultrasound elasticity index ratio and elasticity index methods in differential diagnosis of different sizes of benign and malignant thyroid nodules. Methods Clinical examination data of patients who were hospitalized for thyroid nodules were collected and were retrospectively analyzed in the Fourth Affiliated Hospital of Harbin Medical University from January 2015 to January 2016. The elasticity index ratio and elasticity index were used to diagnose benign and malignant thyroid nodules, and the results were compared with pathological diagnosis. The thyroid nodules were fell into three groups according to the maximum long diameter： 〈 1, 1 - 2, and 〉 2 cm. Using the above two methods, the sensitivity, specificity and accuracy were analyzed in benign and malignant thyroid nodules with different sizes. And the receiver operating characteristic curve （ROC） was drawn. Results A total of 90 patients （108 nodules） were enrolled in the study and they were from thyroid nodular surgery, 28 male cases, 62 female cases, mean age （44.1 -＋ 11.5） years, and ranged from 20 to 69 years old. Seventy benign nodules and 38 malignant nodules were diagnosed with pathology. Sixty- three benign nodules and 45 malignant nodules were diagnosed via the ultrasound elasticity index ratio method. Compared with the pathological diagnosis, 13 were misdiagnosed and 6 were omission diagnosed in malignant thyroid nodules. Sixty-three benign nodules and 45 malignant nodules were diagnosed via the ultrasound elasticity index method. Compared with the pathological diagnosis, 16 were misdiagnosed and 9 were omission diagnosed in malignant thyroid nodules. Sensitivities of elasticity index ratio method in 〈 1, 1 - 2, and 〉 2 cm groups were 91.7%, 86.0%, and 75.0%; specificities were 88.9%, 78.6%, and 79.2%, and accuracies were 90.0%, 81.0%, and 77.8%; and differences in sensitivity and accuracy of the two methods were statistically significant （χ^2= 76.4, 70.8, P 〈 0.05）. Sensitivities of elasticity index method in 〈 1, 1 - 2, and 〉 2 cm were 83.3%, 78.6%, and 66.7%; specificities were 83.3%, 75.0%, and 75.0%, and accuracies were 83.3%, 76.0%, and 72.2%. Differences in sensitivity and accuracy of the two methods were statistically significant （χ^2 = 82.8, 74.5, P 〈 0.05）. The area under the ROC curve of elasticity index ratio and of elasticity index was 0.814 and 0.766, respectively, and the difference was statistically significant （Z = 0.896. P 〈 0.05）. Conclusions In the differential diagnosis of different sizes of benign and malignant thyroid nodules, the elasticity index ratio method is better than the elasticity index method. The diagnostic value on -〈2 cm nodules is higher.
出处
《中华地方病学杂志》
CSCD
北大核心
2017年第12期916-919,共4页
Chinese Journal of Endemiology
基金
黑龙江省科学基金（ZD2017016）
关键词
甲状腺结节
弹性成像
弹性指数比值法
弹性指数法
Thyroid nodule
Uhrasound elastography
Elasticity index ratio
Elasticity index
