| 摘要: |
| 目的 探讨常规超声和应变弹性成像对细胞学诊断不确定（即Bethesda Ⅲ、Ⅳ、Ⅴ类）甲状腺结节的诊断价值。方法 对有病理结果证实的细胞学诊断为Bethesda Ⅲ、Ⅳ、Ⅴ类的135个结节的常规超声及弹性图像进行回顾分析，比较细胞学诊断不确定的良恶性结节的超声特征差异，比较常规超声及其联合弹性成像对细胞学不确定的甲状腺结节恶性风险的评估能力。结果 135个结节中，112个（83%）结节手术病理为恶性，23个（17%）结节手术病理为良性。常规超声征象预测细胞学不确定恶性结节的敏感性，特异性，准确性，阳性预测值及阴性预测值分别为 95.54%，56.52%，88.89%，91.45%及72.22%，而常规超声联合弹性评分≥3分预测细胞学不确定恶性结节的敏感性，特异性，准确性，阳性预测值及阴性预测值分别为98.21%，30.43%，86.67%，87.3% 及77.78%。联合弹性成像，常规超声的诊断效能降低（P=0.03）。结论 常规超声及弹性成像在细胞学诊断不确定结节良恶性鉴别诊断方面有价值。但是联合弹性成像，未能提高常规超声特征对细胞学诊断不确定结节中恶性肿瘤的预测能力。 |
| 关键词: 超声弹性成像 甲状腺结节 细胞学诊断不确定 Bethesda Ⅲ/Ⅳ/Ⅴ 类 |
| DOI： |
| 投稿时间：2019-07-10修订日期：2019-07-21 |
| 基金项目:国家自然科学基金项目（面上项目，重点项目，重大项目） |
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| The diagnostic performance of conventional sonography and strain elastography in thyroid nodules with indeterminate cytology |
| Wu Lilu,Xu Fangting,Sun Yang,Luo Jieli,Huang Pintong |
| (the Second Affiliated Hospital of Zhejiang University School of Medicine) |
| Abstract: |
| Objectives To evaluate the diagnostic performance of conventional sonography and strain elastography in thyroid nodules with indeterminate cytologic（i.e. BethesdaⅢ/Ⅳ/Ⅴ）findings. Methods This retrospective analysis enrolled 135 nodules surgically treated at our hospital with indeterminate results on fine-needle aspiration (FNA) cytology. Ultrasound images of the 135 nodules were retrospectively analyzed.The elastogram was matched with an elasticity color scale and classified by amended 5-point scoring criteria.Differences in sonographic characteristic between the benign and malignant nodules were assessed.The diagnostic performance of conventional sonography and strain elastography in thyroid nodules with indeterminate cytology were investigated.Results A total of 112 nodules (83%) were malignant ; 23 (17%) were benign. The association of conventional sonographic features identified 107 of 112 thyroid cancers (sensitivity, 95.54%; specificity, 56.52%; accuracy, 88.89%;positive predictive value, 91.45% and negative predictive value,72.22% ), whereas the association of conventional sonographic features plus elastographic scores of ≥3 identified 110 of 112 thyroid cancers (sensitivity, 98.21%; specificity, 30.43%; accuracy, 86.67%;positive predictive value, 87.3% and negative predictive value,77.78% ).Conclusions Our data suggest that elastography could be a promising tool in the management of nodules with indeterminate cytologic findings. But the combination of conventional sonographic features and elastographic scores showed inferior diagnostic performances in predicting malignant nodules with indeterminate FNA cytology results in comparison with the association of conventional sonographic features alone. |
| Key words: Strain elastography Thyroid nodule Indeterminate cytology Bethesda Ⅲ/Ⅳ/Ⅴ |
