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目的探讨常规超声、超声弹性成像及两者联合鉴别甲状腺微小结节良恶性的临床价值。方法回顾性分析2013年3月至2016年6月健康体检中发现甲状腺微小结节(最大径≤10 mm)的98例患者117个结节的常规超声及弹性成像图像资料,所有病例均经穿刺或手术病理证实。以手术病理结果作为对照,计算常规超声、超声弹性成像及两者联合鉴别诊断甲状腺微小结节良恶性的准确率、敏感度、特异度、阳性预测值、阴性预测值。绘制受试者操作特征(ROC)曲线,计算ROC曲线下面积。结果常规超声鉴别诊断甲状腺微小结节良恶性的准确率为80.34%(94/117),敏感度为87.21%(75/86),特异度为61.29%(19/31),阳性预测值为86.21%(75/87),阴性预测值为63.33%(19/30);超声弹性成像鉴别诊断甲状腺微小结节良恶性的准确率为71.79%(84/117),敏感度为69.77%(60/86),特异度为77.42%(24/31),阳性预测值为89.55%(60/67),阴性预测值为48.00%(24/50);两者联合鉴别诊断甲状腺微小结节良恶性的准确率为86.32%(101/117),敏感度为96.51%(83/86),特异度为58.06%(18/31),阳性预测值为86.46%(83/96),阴性预测值为85.71%(18/21)。常规超声、超声弹性成像及两者联合应用鉴别诊断甲状腺微小结节良恶性的ROC曲线下面积分别为0.742、0.736、0.773。结论常规超声可作为甲状腺微小结节良恶性鉴别诊断的常规检查技术,超声弹性成像可作为常规超声的必要补充,两者联合应用可进一步提高甲状腺微小结节良恶性鉴别诊断的效能。
Objective To investigate the clinical value of conventional ultrasound, ultrasound elastography and the combination of the two in the identification of benign and malignant thyroid nodules. Methods A retrospective analysis of routine ultrasound and elastography images of 117 nodules from 98 patients with minimal thyroid nodules (maximum diameter ≤10 mm) found during the physical examination from March 2013 to June 2016 was performed. All cases were punctured Or surgical pathology confirmed. Surgical pathology results as a control, calculate the accuracy, sensitivity, specificity, positive predictive value, negative predictive value of conventional ultrasound, ultrasound elastography and the combination of the two in the diagnosis of benign and malignant thyroid nodules. The receiver operating characteristic (ROC) curve was plotted and the area under the ROC curve was calculated. Results The accuracy of routine ultrasound in the diagnosis of benign and malignant thyroid nodules was 80.34% (94/117), the sensitivity was 87.21% (75/86), the specificity was 61.29% (19/31), the positive predictive value was 86.21 % (75/87), and the negative predictive value was 63.33% (19/30). The accuracy of ultrasound elastography in differentiating benign and malignant thyroid nodules was 71.79% (84/117) and the sensitivity was 69.77% (60 / 86), the specificity was 77.42% (24/31), the positive predictive value was 89.55% (60/67), and the negative predictive value was 48.00% (24/50). The combined diagnosis of benign and malignant thyroid nodules The accuracy was 86.32% (101/117), the sensitivity was 96.51% (83/86), the specificity was 58.06% (18/31), the positive predictive value was 86.46% (83/96), the negative predictive value was 85.71 % (18/21). The area under the ROC curve of conventional and ultrasonographic elastography and the combination of the two in the differential diagnosis of benign and malignant thyroid nodules were 0.742, 0.736 and 0.73. Conclusion Conventional ultrasound can be used as a routine diagnostic technique for the differential diagnosis of benign and malignant thyroid nodules. Ultrasound elastography can be used as a necessary complement to conventional ultrasound. The combination of the two can further improve the differential diagnosis of benign and malignant thyroid nodules.