CAJ | 학술논문

目的：评估二维超声（2DUS）评分法及超声造影（CEUS）诊断甲状腺微小癌的价值。方法对2011年6月至2013年10月在宁波市第一医院欲行手术治疗的216例连续的微小甲状腺结节患者（共计258个结节）行2DUS及CEUS检查，并对每个结节2DUS参数（内部回声、形态、边界、钙化、纵横比）分别赋值评分，评估2DUS评分法及CEUS诊断甲状腺微小癌的敏感度、特异度及准确性。结果258个甲状腺微小结节均获得病理诊断，其中微小癌125个，良性结节133个，每个甲状腺微小结节2DUS评分分值为0~6分，2DUS诊断甲状腺微小癌受试者操作特性（ROC）曲线下面积为0.81，以评分≥3分诊断甲状腺微小癌的敏感度为78.4%（98/125），特异度为72.9%（97/133），准确性为75.6%（195/258）；甲状腺微小结节CEUS模式分为早期低增强、低增强、等增强、高增强、局部无增强、无增强及环状增强。以早期低增强及低增强诊断甲状腺微小癌，CEUS诊断甲状腺微小癌敏感度、特异度及准确性分别为87.2%（109/125）、75.9%（101/133）、81.4%（210/258）。2DUS评分法及CEUS诊断甲状腺微小癌敏感度、特异度及准确性差异无统计学意义（McNemar检验，P=0.099、0.608、0.096）。结论 CEUS早期低增强及低增强为甲状腺微小癌较特异增强模式， CEUS鉴别甲状腺微小良恶性结节效能较2DUS评分法稍高，但差异无统计学意义。
목적：평고이유초성（2DUS）평분법급초성조영（CEUS）진단갑상선미소암적개치。방법대2011년6월지2013년10월재저파시제일의원욕행수술치료적216례련속적미소갑상선결절환자（공계258개결절）행2DUS급CEUS검사，병대매개결절2DUS삼수（내부회성、형태、변계、개화、종횡비）분별부치평분，평고2DUS평분법급CEUS진단갑상선미소암적민감도、특이도급준학성。결과258개갑상선미소결절균획득병리진단，기중미소암125개，량성결절133개，매개갑상선미소결절2DUS평분분치위0~6분，2DUS진단갑상선미소암수시자조작특성（ROC）곡선하면적위0.81，이평분≥3분진단갑상선미소암적민감도위78.4%（98/125），특이도위72.9%（97/133），준학성위75.6%（195/258）；갑상선미소결절CEUS모식분위조기저증강、저증강、등증강、고증강、국부무증강、무증강급배상증강。이조기저증강급저증강진단갑상선미소암，CEUS진단갑상선미소암민감도、특이도급준학성분별위87.2%（109/125）、75.9%（101/133）、81.4%（210/258）。2DUS평분법급CEUS진단갑상선미소암민감도、특이도급준학성차이무통계학의의（McNemar검험，P=0.099、0.608、0.096）。결론 CEUS조기저증강급저증강위갑상선미소암교특이증강모식， CEUS감별갑상선미소량악성결절효능교2DUS평분법초고，단차이무통계학의의。
Objective To evaluate the diagnostic value of 2D ultrasound (2DUS)-based composite score method and contrast enhanced ultrasound (CEUS) in differentiation between thyroid microcarcinomas and benign micronodules. Methods A total of 216 consecutive patients with 258 thyroid micronodules underwent 2DUS and CEUS examinations before thyroidectomy from June 2011 to October 2013. The scoring of each nodule was based on five 2DUS features including hypoechogencity, irregular shape, macrocalcification, and taller than wide in shape. Microcalciifcation was assigned as 2 points and the remaining features were assigned as 1 point. A composite score was ifnally given to each thyroid nodule ranging from 0 to 6 points. The sensitivity, specificity and accuracy of diagnosing thyroid microcarcinoma by 2DUS composite score method and CEUS were calculated. Results The histopathologic results of all 258 nodules were acquired, including 125 papillary microcarcinomas and 133 benign micronodules. Each nodule′s 2DUS compostie score was ranging from 0 to 6 points. The area of receiver operating characteristic (ROC) curve of 2DUS in diagnosing thyroid microcarcinoma was 0.81. The 2DUS composite score method predicted the thyroid microcarcinoma with sensitivity of 78.4%(98/125), speciifcity of 72.9%(97/133), accuracy of 75.6%(195/258), when the nodule with a score greater than or equal to 3 points was deifned as malignant. Thyroid micronodules′enhancement pattern were divided into 7 types, including early hypoenhancement, hypoenhancement, isoenhancement, hyperenhancement, local nonenhancement, nonenhancement, and ring margin ring enhancement. CEUS predicted thyroid malignant micronodules with sensitivity of 87.2%(109/125), specificity of 75.9%(101/133), and accuracy of 81.4%(210/258), when early hypoenhancement and hypoenhancement pattern was defined as malignant patterns. There were no differences in sensitivity, specificity, and accuracy between 2DUS cumulative score method and CEUS in diagnosing thyroid microcarcinoma (McNemar test, P=0.099, 0.608, 0.096). Conclusion Early hypoenhancement and hypoenhancement are CEUS characteristic enhancement pattern for thyroid microcarcinoma, CEUS has higher sensitivity, speciifcity in diagnosis than 2DUS composite score method, while there are no statistical differences.