CAJ | 학술논문

目的：探讨细胞学未定性甲状腺结节的恶性预测因子。方法：回顾性搜集2009年-2013年88例细胞学检查未定性甲状腺结节患者的相关资料。对选定结节进行临床、实验室、MRI、超声和穿刺细胞学（Bethesda 分类标准）多方面分析研究，多变量分析后建立预测模型。结果：88例中有25例甲状腺结节为恶性病变（28．41％，25/88）。对比分析良性结节组和恶性结节组，两组中患者的性别、血清FT4水平、有无甲状腺自身免疫性疾病、微钙化的 MRI 特征、结节中央血流丰富的US特征在两组间差异均无统计学意义（P＞0．05）。微钙化的US特征、边界模糊的 MRI特征以及细胞学结果分类第Ⅳ类（Bethesda分类系统）在两组间差异有统计学意义（P＜0．05）。在多变量分析后，预测模型表明Bethesda 分类Ⅳ类和微钙化的US特征以及边界模糊的 MRI 特征均可作为未定性甲状腺结节的恶性预测因子，符合率为88．6％。结论：研究证实Bethesda分类Ⅳ、微钙化的US特征、边界模糊的 MRI特征均是未定性甲状腺结节的恶性预测因子。
목적：탐토세포학미정성갑상선결절적악성예측인자。방법：회고성수집2009년-2013년88례세포학검사미정성갑상선결절환자적상관자료。대선정결절진행림상、실험실、MRI、초성화천자세포학（Bethesda 분류표준）다방면분석연구，다변량분석후건립예측모형。결과：88례중유25례갑상선결절위악성병변（28．41％，25/88）。대비분석량성결절조화악성결절조，량조중환자적성별、혈청FT4수평、유무갑상선자신면역성질병、미개화적 MRI 특정、결절중앙혈류봉부적US특정재량조간차이균무통계학의의（P＞0．05）。미개화적US특정、변계모호적 MRI특정이급세포학결과분류제Ⅳ류（Bethesda분류계통）재량조간차이유통계학의의（P＜0．05）。재다변량분석후，예측모형표명Bethesda 분류Ⅳ류화미개화적US특정이급변계모호적 MRI 특정균가작위미정성갑상선결절적악성예측인자，부합솔위88．6％。결론：연구증실Bethesda분류Ⅳ、미개화적US특정、변계모호적 MRI특정균시미정성갑상선결절적악성예측인자。
Objective:To study the predictive factors of malignant thyroid nodules with indeterminate cytological diag-nosis of fine needle aspiration biopsy.Methods:Clinical data of 88 patients with thyroid nodules with indeterminate cytologi-cal examination results in our hospital from 2009 to 2013 were retrospectively collected.The clinical,laboratory,MRI,US and cytological classification (Bethesda criteria)variables of these selected cases were analyzed,and a prediction model was designed after the multivariate analysis.Results:There were 25 cases with malignant thyroid nodules (28.41%,25/88).Be-tween benign and malignant nodule groups,there were no significant differences in gender,FT4 blood levels,with autoim-mune thyroid disease,rich blood flow in central region by US;there were significant differences in micro-calcifications on US,blurry border on MRI and the Bethesda System category IV.The established multivariate analysis model showed the Bethesda System category IV together with micro-calcifications on US and blurry border on MRI were predictive factors of malignant thyroid nodules,with 88.6% diagnostic accuracy.Conclusion:This study confirmed Bethesda System category IV together with micro-calcifications on US and blurry border on MRI were predictive factors of malignancy in indeterminate thyroid nodules.