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目的比较超声检查和病理测量甲状腺乳头状癌(papillary thyroid carcinoma,PTC)肿瘤大小的差异,并分析其临床意义。方法选取2012年6月~2014年6月杭州市第一人民医院收治的PTC 114例(共122枚癌灶),昕有癌灶大小先后通过术前超声检查和术后组织病理测量确定,采用Pearson相关分析、配对t检验和Bland-Altman作图评价两种方法测量肿瘤大小的差异性和一致性。结果Pearson相关显示两种方法测量的肿瘤最大径存在显著正相关(r=0.957,P=0.000)。配对t检验显示肿瘤的超声最大径(8.24±5.06)mm与病理最大径(7.79±4.75)mm存在显著性差异。Bland-Altman分析显示,两种方法测量的肿瘤最大径的差值绝对值介于0~6.5 mm之间,平均(1.03±1.14)mm,差值的一致性界限(limits of agreement,LoA)为_2.41 mm~3.33 mm,LoA的95%置信区间为.2.87 mm~3.78 mm,LoA置信区间范围内差值的最大绝对值为2.9 mm。结论超声检查和病理测量PTC的肿瘤大小存在显著差异,两者的一致性欠佳,临床实践中应引起重视。
Objective To compare the difference of tumor size between papillary thyroid carcinoma (PTC) and ultrasonography and pathology, and to analyze its clinical significance. Methods From June 2012 to June 2014, 114 patients with PTC (total 122 lesions) were enrolled in Hangzhou First People’s Hospital. The size of the lesion was determined by preoperative ultrasonography and postoperative histopathological measurement. Pearson correlation analysis, paired t test and Bland-Altman mapping evaluation of two methods of measuring tumor size differences and consistency. Results The Pearson correlation showed a significant positive correlation (r = 0.957, P = 0.000) for the maximum diameter of the tumors measured by the two methods. Paired t-test showed that the maximum diameter of tumor (8.24 ± 5.06) mm and pathological maximum diameter (7.79 ± 4.75) mm there is a significant difference. The Bland-Altman analysis showed that the absolute value of the difference between the maximum diameters measured by the two methods ranged from 0 to 6.5 mm with an average of (1.03 ± 1.14) mm. The limits of agreement (LoA) _2.41 mm to 3.33 mm, the 95% confidence interval for LoA is 2.87 mm to 3.78 mm, and the maximum absolute value of the difference within the LoA confidence interval is 2.9 mm. Conclusion Ultrasound examination and pathological measurement of PTC tumor size there are significant differences between the two poor agreement, clinical practice should pay attention.