CAJ | 학술논문

目的：探讨超声综合评分法在诊断不同直径甲状腺结节良恶性中的价值。方法对301个甲状腺结节进行常规超声检查，根据结节大小分为A组（90个，直径≤1．0 cm）、B组（130个，直径1．1～1．9 cm），C组（81个，直径≥2．0 cm）。选取具有诊断价值的5个超声征象：低回声或极低回声、纵横比＞1、边界不清晰、微小钙化及Rago血管分型Ⅲ型，根据其征象赋值，符合者记为1，不符合者记为0，计算结节综合评分。所有结节均经术后病理证实，以病理结果作为金标准构建ROC曲线，比较超声综合评分法对不同直径甲状腺结节的诊断价值。结果三组中恶性结节的评分均明显高于同组良性结节（P＜0．05）。三组间良性结节比较差异均有统计学意义（P＝0．000），C组评分低于A组（P＝0．000）和B组（P＝0．01）， A、B组比较差异无统计学意义；三组间恶性结节评分比较差异无统计学意义。三组ROC曲线下面积分别为0．65、0．79及0．88，超声评分法对C组的诊断价值明显高于A组（Z＝3．07， P＜0．01）和B组（Z＝1．98，P＜0．05），A、B组诊断价值比较差异无统计学意义（Z＝1．40）。结论超声综合评分法在诊断不同直径甲状腺结节良恶性中有一定价值，肿块直径越大诊断价值越高。
목적：탐토초성종합평분법재진단불동직경갑상선결절량악성중적개치。방법대301개갑상선결절진행상규초성검사，근거결절대소분위A조（90개，직경≤1．0 cm）、B조（130개，직경1．1～1．9 cm），C조（81개，직경≥2．0 cm）。선취구유진단개치적5개초성정상：저회성혹겁저회성、종횡비＞1、변계불청석、미소개화급Rago혈관분형Ⅲ형，근거기정상부치，부합자기위1，불부합자기위0，계산결절종합평분。소유결절균경술후병리증실，이병리결과작위금표준구건ROC곡선，비교초성종합평분법대불동직경갑상선결절적진단개치。결과삼조중악성결절적평분균명현고우동조량성결절（P＜0．05）。삼조간량성결절비교차이균유통계학의의（P＝0．000），C조평분저우A조（P＝0．000）화B조（P＝0．01）， A、B조비교차이무통계학의의；삼조간악성결절평분비교차이무통계학의의。삼조ROC곡선하면적분별위0．65、0．79급0．88，초성평분법대C조적진단개치명현고우A조（Z＝3．07， P＜0．01）화B조（Z＝1．98，P＜0．05），A、B조진단개치비교차이무통계학의의（Z＝1．40）。결론초성종합평분법재진단불동직경갑상선결절량악성중유일정개치，종괴직경월대진단개치월고。
Objective To evaluate the diagnostic value of ultrasonographic scoring system in discriminating benign and malignant thyroid nodules with different diameters. Methods A total of 301 thyroid gland nodules were divided into group A (n=90,≤1.0 cm),group B(n=130, 1.1~1.9 cm) and group C(n=81,≥2.0 cm) according to their maximum diameters ,and all their sonographic features were obtained . Five ultrasonographic features with the best diagnostic value including marked hypo-echogenicity,anteroposterior/transverse diameter ratio>1, irregular shape,microcalcifications and Rago’s typeⅢ were selected to be scored 1 point, otherwise, it was scored 0, and finally the total points were calculated. Receive operating characteristic (ROC) curve was drawn with the pathological results as standards. Results The total points of each malignant group were higher than those of benign group(P<0.05),the score of benign nodes in group C were lower than those in group A(P=0.000) and group B(P=0.01). However, there were no significant differences among the scores of malignant nodules in three groups. The areas under the curves(AUC) of each group were 0.65,0.79 and 0.88,respectively. Compared with the group A and group B,AUC of group C was significantly bigger(ZA=3.07, P<0.01,and ZB=1.98,P<0.05).There was no significant difference between group A and group B(Z=1.40). Conclusion Ultrasonographic scoring system is of a great value in differentiating benign and malignant thyroid nodules with different diameters and plays better with the increase of nodule diameter.