CAJ | 학술논문

目的评价超声造影(CEUS)结合细针穿刺细胞学检查(FNA)对甲状腺癌的诊断价值.方法总结经手术病理证实的165例患者共184个甲状腺结节(良性14个,恶性170个)术前超声引导下细针穿刺细胞学检查(FNA)和CEUS的资料,根据甲状腺结节最大径线分为A组(≤1 cm组)和B组(＞1cm组).以Bethesda System大于Ⅳ级和CEUS不均匀低增强作为甲状腺恶性结节的诊断标准,分别分析FNA、CEUS以及两者联合诊断甲状腺癌的敏感性、特异性、准确率、阳性预测值、阴性预测值.结果 A组(≤1 cm组)中FNA诊断甲状腺癌的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为93.8％、62.5％、92.0％、97.6％、38.5％;CEUS诊断甲状腺癌的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为88.5％、37.5％、85.5％、95.8％、16.7％;FNA与CEUS联合诊断甲状腺癌的敏感性、特异性、准确率、阳性预测值及阴性预测值分别为100％、25.0％、95.7％、95.6％、100％,与单独FNA及CEUS比较敏感性、准确率差异有统计学意义(P =0.013、0.000及P=0.000、0.000);B组(＞1 cm组)中FNA诊断甲状腺癌的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为100％、83.3％、97.8％、97.6％、100％;CEUS诊断甲状腺癌的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为92.5％、83.3％、91.3％、97.4％、62.5％;FNA与CEUS联合诊断甲状腺癌的敏感性、特异性、准确率、阳性预测值及阴性预测值分别为100％、66.7％、95.6％、95.2％、100％,与单独FNA及CEUS比较在敏感性、特异性、准确率、阳性预测值、阴性预测值方面差异均无统计学意义(P＞0.05).结论对于≤1 cm组的甲状腺结节,FNA与CEUS联合诊断可明显提高诊断敏感性及准确率.对于＞1 cm组的甲状腺结节,联合诊断未明显提高诊断准确率、敏感性及特异性.
목적 평개초성조영(CEUS)결합세침천자세포학검사(FNA)대갑상선암적진단개치.방법 총결경수술병리증실적165례환자공184개갑상선결절(량성14개,악성170개)술전초성인도하세침천자세포학검사(FNA)화CEUS적자료,근거갑상선결절최대경선분위A조(≤1 cm조)화B조(＞1cm조).이Bethesda System대우Ⅳ급화CEUS불균균저증강작위갑상선악성결절적진단표준,분별분석FNA、CEUS이급량자연합진단갑상선암적민감성、특이성、준학솔、양성예측치、음성예측치.결과 A조(≤1 cm조)중FNA진단갑상선암적민감성、특이성、준학솔、양성예측치、음성예측치분별위93.8％、62.5％、92.0％、97.6％、38.5％;CEUS진단갑상선암적민감성、특이성、준학솔、양성예측치、음성예측치분별위88.5％、37.5％、85.5％、95.8％、16.7％;FNA여CEUS연합진단갑상선암적민감성、특이성、준학솔、양성예측치급음성예측치분별위100％、25.0％、95.7％、95.6％、100％,여단독FNA급CEUS비교민감성、준학솔차이유통계학의의(P =0.013、0.000급P=0.000、0.000);B조(＞1 cm조)중FNA진단갑상선암적민감성、특이성、준학솔、양성예측치、음성예측치분별위100％、83.3％、97.8％、97.6％、100％;CEUS진단갑상선암적민감성、특이성、준학솔、양성예측치、음성예측치분별위92.5％、83.3％、91.3％、97.4％、62.5％;FNA여CEUS연합진단갑상선암적민감성、특이성、준학솔、양성예측치급음성예측치분별위100％、66.7％、95.6％、95.2％、100％,여단독FNA급CEUS비교재민감성、특이성、준학솔、양성예측치、음성예측치방면차이균무통계학의의(P＞0.05).결론 대우≤1 cm조적갑상선결절,FNA여CEUS연합진단가명현제고진단민감성급준학솔.대우＞1 cm조적갑상선결절,연합진단미명현제고진단준학솔、민감성급특이성.
Objective To evaluate the diagnostic value of the contrast-enhanced ultrasound (CEUS) combined with ultrasound-guided fine needle aspiration biopsy (FNA) for thyroid carcinoma.Methods A retrospective analysis of the clinical data of 165 patients was finished,including 184 thyroid nodules confirmed by pathology (14 benign,170 malignant) and their preoperative FNA and CEUS data.According to the maximal diameter of thyroid nodules,the patients was divided into group A (≤ 1 cm) and group B (＞1 cm).According to the Bethesda System,＞grade Ⅳ was the malignant cytologic criteria for diagnosis of thyroid nodules,and uneven low-enhanced ultrasound was the standard diagnosis of malignant thyroid.Pursuant to which,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of diagnosis for thyroid nodules by FNA,CEUS,and the combination were analyzed respectively.Results In group A,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of single FNA were 93.8％,62.5％,92.0％,97.6％,38.5％,and CEUS diagnosis for thyroid cancer were 88.5％,37.5％,85.5％,95.8％,16.7％,respectively.After FNA and CEUS were combined,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 100％,25.0％,95.7％,95.6％,100％,respectively.When the combined diagnosis compared with single FNA and CEUS,the sensitivity and accuracy were statistically significant (P =0.013,0.000 and P =0.000,0.000).In group B,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of single FNA were 100％,83.3％,97.8％,97.6％,100％,and CEUS diagnosis for thyroid cancer were 92.5％,83.3％,91.3％,97.4％,62.5％,respectively.After FNA and CEUS were combined,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 100％,66.7％,95.6％,95.2％,100％,respectively.For each pairwise comparison,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were not statistically different (P ＞0.05).Conclusions For thyroid nodules ≤ 1cm,the combined diagnosis of FNA and CEUS can significantly improve the diagnostic sensitivity and accuracy.While for thyroid nodules ＞ 1 cm,the combined diagnosis does not change the diagnostic accuracy,sensitivity and specificity.