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| 多基因检测联合应变弹性成像鉴别诊断细胞学不确定甲状腺结节良恶性的价值 |
| 施丽丹,强旭钊 |
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| (宁德师范学院附属宁德市医院 内分泌科) |
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| 摘要: |
| 目的：探讨多基因检测与应变弹性成像在细胞学不确定的甲状腺结节良恶性的鉴别诊断价值。方法：选取124例患有甲状腺结节患者作为研究对象,选取时间为2019年5月至2020年6月,经病理结果证实且细胞学诊断为IC的甲状腺结节136个(Bethesda Ⅲ、Ⅳ、Ⅴ类),其中恶性结节91个,良性结节45个,均予以多基因与应变弹性成像技术检测,采用四格表法计算阳性预测值、阴性预测值；采用ROC曲线模型分析多基因检测、应变弹性成像、两项联合鉴别诊断细胞学不确定的甲状腺结节良恶性的AUC值、敏感度、特异度。结果：124例患有甲状腺结节患者经多基因检测后,阳性预测值为89.13%,阴性预测值为79.55%,与金标准相比,一致性一般(Kappa=0.683,P＜0.05)；经应变弹性成像检查后,阳性预测值为78.88%,阴性预测值为56.52%,与金标准相比,一致性较差(Kappa=0.356,P＜0.001)。经两项联合检查后,阳性预测值为97.80%,阴性预测值为95.56%,与金标准相比,一致性较好(Kappa=0.934,P＜0.001)。其中,多基因检测的检出率与应变弹性成像相比,差异具有统计学意义(χ2=8.766,P＜0.05)；多基因检测的检出率与两项联合相比,差异具有统计学意义(χ2=10.686,P＜0.05)；应变弹性成像与两项联合相比,差异有统计学意义(χ2=33.838,P＜0.05)。经多基因检出的82个甲状腺恶性结节中,基因突变占74个,基因融合占8个。经应变弹性成像检出的71个甲状腺恶性结节中,弹性评分为4分共28个、为5分共42个。ROC曲线分析显示,多基因检测、应变弹性成像、两项联合鉴别诊断细胞学不确定的甲状腺结节良恶性的AUC值分别为(0.848、0.680、0.968,P＜0.05)；敏感度分别82.00%、71.00%、96.00%；特异度分别为87.50%、65.00%、97.50%。结论：多基因检测与应变弹性成像技术比较,前者的细胞学不确定甲状腺结节良恶性检出率更高,但两者联合有利于进一步提高检出率。 |
| 关键词: 多基因 应变弹性成像 细胞学诊断不确定 甲状腺结节 良恶性 |
| DOI： |
| 投稿时间：2022-03-05修订日期：2022-04-15 |
| 基金项目: |
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| Differential diagnostic value of polygenic detection and strain elastography in benign and malignant thyroid nodules with uncertain cytology |
| shilidan,qiangxuzhao |
| (ningdeshifanxueyuanfushuningdeshiyiyuan) |
| Abstract: |
| Objective: To investigate the value of polygenic detection and strain elastography in the differential diagnosis of benign and malignant thyroid nodules with uncertain cytology. Methods: A total of 124 patients with thyroid nodules were selected as the research subjects. The selection time was from May 2019 to June 2020. There were 136 thyroid nodules confirmed by pathological results and diagnosed as IC by cytology (Bethesda Ⅲ, Ⅳ, Ⅴ categories). ), 91 malignant nodules and 45 benign nodules were detected by polygene and strain elastography, and the positive predictive value and negative predictive value were calculated by the four-table method; the ROC curve model was used to analyze the polygene detection, strain AUC value, sensitivity and specificity of elastography and two combined differential diagnosis of benign and malignant thyroid nodules with uncertain cytology.Results: After polygenic detection of 124 patients with thyroid nodules, the positive predictive value was 89.13% and the negative predictive value was 79.55%. Compared with the gold standard, the consistency was general (Kappa=0.683, P<0.05). After imaging examination, the positive predictive value was 78.88% and the negative predictive value was 56.52%, which showed poor agreement compared with the gold standard (Kappa=0.356, P<0.001). After the two combined examinations, the positive predictive value was 97.80% and the negative predictive value was 95.56%. Compared with the gold standard, the consistency was better (Kappa=0.934, P<0.001). Among them, the detection rate of polygenic detection was significantly different from that of strain elastography (χ2=8.766, P<0.05); the detection rate of polygenic detection was significantly different from the combination of the two. (χ2=10.686, P<0.05); the difference was statistically significant between strain elastography and the combination of the two items (χ2=33.838, P<0.05). Among the 82 malignant thyroid nodules detected by multiple genes, 74 were gene mutations and 8 were gene fusions. Among the 71 malignant thyroid nodules detected by strain elastography, 28 were scored as 4, and 42 were scored as 5. ROC curve analysis showed that the AUC values ??of polygenic detection, strain elastography, and two combined differential diagnosis of benign and malignant thyroid nodules with uncertain cytology were (0.848, 0.680, 0.968, P<0.05), respectively; the sensitivity was 82.00%, respectively , 71.00%, 96.00%; the specificity was 87.50%, 65.00%, 97.50%, respectively. Conclusion: Compared with strain elastography, the former has a higher detection rate of benign and malignant thyroid nodules with uncertain cytology, but the combination of the two is beneficial to further improve the detection rate. |
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