多模态超声诊断C-TIRADS4类细针穿刺细胞学检查TBSRTC Ⅲ类甲状腺结节的价值

邵春晖; 李培英; 赵君智; 罗永科; 吕品; 张毅

doi:10.16766/j.cnki.issn.1674-4152.003928

多模态超声诊断C-TIRADS4类细针穿刺细胞学检查TBSRTC Ⅲ类甲状腺结节的价值

doi: 10.16766/j.cnki.issn.1674-4152.003928

1.
宝鸡市人民医院超声医学科，陕西宝鸡 721000
2.
西安医学院附属宝鸡医院超声医学科，陕西宝鸡 721006
3.
中国人民解放军联勤保障部队第九八七医院超声诊断科，陕西宝鸡 721000

基金项目:

陕西省重点研发计划项目 2023-YBSF-011

宝鸡市卫生健康委员会科研计划立项项目 2024-052

详细信息

通讯作者:
张毅，E-mail：1020659957@qq.com

中图分类号: R445.1 R736.1
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出版历程
- 收稿日期: 2024-07-15

The value of multimodal ultrasound in the diagnosis of C-TIRADS4 fine needle aspiration cytology for TBSRTC Type Ⅲ thyroid nodules

1.
Department of Ultrasound Medicine, Baoji People ' s Hospital, Baoji, Shaanxi 721000, China

摘要

摘要: 目的探讨多模态超声定量参数诊断C-TIRADS4类细针穿刺细胞学(FNAC)检查TBSRTC Ⅲ类甲状腺结节的价值。方法选取2023年1月—2024年1月在宝鸡市人民医院经手术病理证实的126个甲状腺C-TIRADS4类FNAC检查为TBSRTC Ⅲ类结节标本的超声造影和弹性成像数据、FNAC细胞学图片及术后病理学结果，以术后病理结果为分组标准，其中恶性组结节83个，良性组结节43个。应用超声造影(CEUS)参数[造影剂达峰强度(PI)、时间-强度曲线的曲线下面积(TIC-AUC)]、应变弹性成像(SE)参数[应变平均值(SEmean)、应变比(SR)]和剪切波弹性成像(SWE)参数[弹性平均值(Emean)、弹性比(ER)]比较2组间差异。采用ROC曲线分析各参数的诊断价值及多模态超声联合应用的诊断效能。结果良性组PI、TIC-AUC、SEmean均值均高于恶性组(P＜0.05)，SR、Emean及ER均低于恶性组(P＜0.05)。多模态超声诊断的AUC(95% CI)、灵敏度、特异度、Youden指数分别为0.912(0.849~0.955)、96.39%、86.05%、0.824，均显著高于单一超声诊断模式。PI、TIC-AUC与多模态超声ROC曲线成对比较，多模态超声 vs. PI、多模态超声 vs. TIC-AUC差异均有统计学意义(Z=2.750、2.293，P＜0.05)。结论多模态超声定量参数有助于提高C-TIRADS4类FNAC检查病理诊断为TBSRTC Ⅲ类甲状腺结节的诊断价值。
- 甲状腺结节 /
- 中国甲状腺影像报告和数据系统 /
- 细针穿刺细胞学检查 /
- 超声造影 /
- 应变弹性成像 /
- 剪切波弹性成像
Abstract: Objective Exploring the diagnostic value of multimodal ultrasound quantitative parameters in the classification of thyroid C-TIRADS4 nodules FNAC as TBSRTC Ⅲ nodules. Methods A total of 126 thyroid C-TIRADS4 type FNAC specimens confirmed by surgical pathology in Baoji People ' s Hospital from January 2023 to January 2024 were selected as TBSRTC type Ⅲ nodules by contrast ultrasonography and elastic imaging, FNAC cytological images and postoperative pathological results. Postoperative pathological results were used as grouping criteria, including 83 nodules in the malignant group and 43 nodules in the benign group. CEUS parameters (PI, TIC-AUC), SE parameters (SEmean, SR), and SWE parameters (Emean, ER) were used to compare the differences between the two groups. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of each parameter and the diagnostic efficiency of multi-mode ultrasound combined application. Results The mean values of PI, TIC-AUC, and SEmean in the benign group were higher than those in the malignant group (P < 0.05), while SR, Emean, and ER were lower than those in the malignant group (P < 0.05). The AUC (95% CI), sensitivity, specificity, and Youden index of multimodal ultrasound diagnosis were 0.912 (0.849-0.955), 96.39%, 86.05%, and 0.824, respectively, which were significantly higher than that of single ultrasound diagnosis mode. PI and TIC-AUC were pairwise compared with ROC curves of multi-mode ultrasound, and there were statistically significant differences between multi-mode ultrasound vs. PI and multi-mode ultrasound vs. TIC-AUC (Z=2.750, 2.293, P < 0.05). Conclusion The quantitative parameters of multimodal ultrasound can improve the diagnostic value of C-TIRADS4 type FNAC examination and pathological diagnosis of TBSRTC type Ⅲ thyroid nodules.
- Thyroid nodule /
- China Thyroid Imaging Reporting and Data System /
- Fine needle aspiration cytology /
- Contrast-enhanced ultrasound /
- Strain elastography /
- Shear-wave elastic imaging
利益冲突 无

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图 1 甲状腺C-TIRADS4a类结节与周围正常腺体超声造影TIC拟合曲线图、SE和SWE图

注：A为甲状腺右侧叶正常腺体(黄色曲线)与C-TIRADS4a类结节(红色曲线)超声造影TIC拟合曲线；B为甲状腺右侧叶C-TIRADS4a类结节弹性平均值Emean=43.76 kPa，周围正常甲状腺组织弹性平均值Emean=15.56 kPa，结节弹性比ER=2.81；C为甲状腺右侧叶C-TIRADS4a类结节应变平均值SEmean=0.11%，周围正常甲状腺组织应变平均值SEmean=0.31%，结节应变比SR=2.90。

Figure 1. CEUS TIC fitting curves, SE and SWE plots of C-TIRADS4a thyroid nodule and surrounding normal glands

下载: 全尺寸图片幻灯片

图 2 CEUS、SE、SWE各参数ROC曲线

Figure 2. ROC curves of CEUS, SE and SWE parameters

下载: 全尺寸图片幻灯片

图 3 多模态超声与CEUS参数ROC曲线比较

Figure 3. Comparison of ROC curves between multi-mode ultrasound and CEUS arameters

下载: 全尺寸图片幻灯片

表 1 2组甲状腺C-TIRADS4类结节CEUS、SE、SWE各参数比较[M(P₂₅, P₇₅)]

Table 1. Comparison of CEUS, SE and SWE parameters of C-TIRADS4 thyroid nodules between the two groups [M(P₂₅, P₇₅)]

结节性质	例数	CEUS		SE		SWE
结节性质	例数	PI(dB)	TIC-AUC(dB·s)	SEmean(%)	SR	Emean(KPa)	ER
恶性组	83	9.8(8.9, 11.0)	616.8(599.6, 630.7)	0.1(0.1, 0.1)	2.6(1.6, 2.9)	36.8(19.5，47.9)	2.9(2.5, 3.2)
良性组	43	20.6(18.1, 22.0)	999.2(963.3, 1 094.2)	0.2(0.1, 0.3)	1.1(1.0, 1.7)	17.2(15.7, 32.1)	1.3(1.0, 2.7)
Z值		6.862	6.511	4.862	-4.596	-4.224	-4.482
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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表 2 CEUS、SE、SWE各参数及多模态超声诊断甲状腺恶性结节的价值

Table 2. Value of CEUS, SE, SWE parameters and multimodal ultrasound in diagnosis of thyroid malignant nodules

指标	AUC	95% CI	P值	最佳截点	灵敏度(%)	特异度(%)	约登指数
CEUS参数
PI(dB)	0.874^a	0.803~0.926	＜0.001	≤12.77	90.36	81.40	0.718
TIC-AUC(dB·s)	0.855^a	0.781~0.911	＜0.001	≤909.44	92.77	81.40	0.742
SE参数
SEmean(%)	0.764^b	0.680~0.835	＜0.001	≤0.15	83.13	69.77	0.529
SR	0.750^b	0.665~0.823	＜0.001	＞2.12	72.29	81.40	0.537
SWE参数
Emean(kPa)	0.730^b	0.644~0.805	＜0.001	＞19.32	75.90	60.47	0.364
ER	0.734^b	0.648~0.809	＜0.001	＞2.46	77.11	67.44	0.445
多模态超声	0.912	0.849~0.955	＜0.001		96.39	86.05	0.824
注：与多模态超声比较，^aP＜0.05；与CEUS参数PI、TIC-AUC比较，^bP＜0.05。

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