Value of biopsy by contrast-enhanced ultrasound in diagnosis of nature of type 4 thyroid nodules by thyroid imaging reporting and data system
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摘要:目的
探讨超声造影(CEUS)在细针穿刺活检(FNA)指导甲状腺影像报告和数据系统(TI-RADS)4类甲状腺结节性质诊断中的价值。
方法选取120例TI-RADS 4类甲状腺结节患者作为研究对象。60例患者行CEUS指导下FNA (CEUS组), 另外60例患者行常规超声指导下的FNA (常规超声组)。以病理结果为金标准，采用Kappa一致性检验，分析常规超声指导FNA、CEUS指导FNA对TI-RADS 4类甲状腺结节性质诊断的一致性。
结果120例TI-RADS 4类甲状腺结节患者(138个结节)经病理确诊85个恶性结节，良性结节53个。其中, CEUS组良性结节28个，恶性结节42个(甲状腺乳头状癌40个，髓样癌2个)，常规超声组良性结节25个，恶性结节43个(甲状腺乳头状癌39个，髓样癌4个)。常规超声指导FNA诊断TI-RADS 4类甲状腺恶性结节的误诊率、漏诊率分别为3.62%、5.07%。CEUS指导FNA诊断TI-RADS 4类甲状腺恶性结节的误诊率、漏诊率分别为2.17%、2.90%。常规超声指导FNA诊断TI-RADS 4类甲状腺结节性质的敏感度、特异度、准确度分别为83.72%、80.00%、82.35%, Kappa值为0.627。CEUS指导FNA诊断TI-RADS 4类甲状腺结节性质的敏感度、特异度、准确度分别为90.48%、89.29%、90.00%, Kappa值为0.793。经病理检测，常规超声指导FNA、CEUS指导FNA诊断TI-RADS 4类甲状腺恶性结节的符合率分别为79.07%、83.33%, Kappa值分别为0.719、0.786。
结论CEUS指导FNA时，可通过提供高分辨率、实时动态的影像信息，提高诊断TI-RADS 4类甲状腺结节性质的敏感度和特异度。
Abstract:ObjectiveTo investigate the value of contrast-enhanced ultrasound (CEUS) guided fine needle aspiration (FNA) in diagnosing the nature of type 4 thyroid nodules by thyroid imaging reporting and data system (TI-RADS).
MethodsA total of 120 patients with TI-RADS type 4 thyroid nodules were selected as subjects. Sixty patients underwent CEUS-guided FNA (CEUS group), while the other 60 patients underwent conventional ultrasound-guided FNA (conventional ultrasound group). Using pathological results as the gold standard, Kappa consistency tests were used to analyze the diagnostic consistency of conventional ultrasound-guided FNA and CEUS-guided FNA for TI-RADS type 4 thyroid nodules.
ResultsAmong 120 patients with TI-RADS type 4 thyroid nodules (138 nodules), 85 malignant nodules and 53 benign nodules were confirmed by pathology. In the CEUS group, there were 28 benign nodules and 42 malignant nodules (40 papillary thyroid carcinomas and 2 medullary carcinomas). In the conventional ultrasound group, there were 25 benign nodules and 43 malignant nodules (39 papillary thyroid carcinomas and 4 medullary carcinomas). The false positive rate and false negative rate of conventional ultrasound-guided FNA for diagnosing malignant TI-RADS type 4 thyroid nodules were 3.62% and 5.07%, respectively. For CEUS-guided FNA, the rates were 2.17% and 2.90%, respectively. The sensitivity, specificity and accuracy of conventional ultrasound-guided FNA for diagnosing the nature of TI-RADS type 4 thyroid nodules were 83.72%, 80.00% and 82.35%, respectively, with Kappa value of 0.627. For CEUS-guided FNA, these values were 90.48%, 89.29% and 90.00%, respectively, with Kappa value of 0.793. Based on pathological examination, the diagnostic agreement rates for malignant TI-RADS type 4 thyroid nodules were 79.07% for conventional ultrasound-guided FNA and 83.33% for CEUS-guided FNA, with Kappa values of 0.719 and 0.786, respectively.
ConclusionCEUS-guided FNA can provide high-resolution, real-time dynamic imaging information, thereby improving the sensitivity and specificity of diagnosing the nature of TI-RADS type 4 thyroid nodules.
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表 3 常规超声、CEUS指导FNA诊断TI-RADS 4类甲状腺结节性质的一致性分析
检查方法 敏感度/% 特异度/% 准确度/% 阳性预测值/% 阴性预测值/% Kappa 常规超声指导FNA 83.72 80.00 82.35 87.80 74.07 0.627 CEUS指导FNA 90.48 89.29 90.00 92.68 86.21 0.793 
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表 4 常规超声指导FNA对TI-RADS 4类甲状腺恶性结节的诊断
常规超声指导FNA 金标准 Kappa 良性(n=25) 甲状腺乳头状癌(n=39) 髓样癌(n=4) 良性 20 7 0 0.719 甲状腺乳头状癌 2 31 1 髓样癌 3 1 3
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表 5 CEUS指导FNA对TI-RADS 4类甲状腺恶性结节的诊断
CEUS指导FNA 金标准 Kappa 良性(n=28) 甲状腺乳头状癌(n=40) 髓样癌(n=2) 良性 23 6 0 0.786 甲状腺乳头状癌 3 33 0 髓样癌 2 1 2
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