摘要
目的探讨超声积分在甲状腺微小实性结节(TSMNs)诊断和鉴别诊断中的应用价值。方法 2009年1月至2013年6月杭州市第一人民医院经手术和病理证实的303例患者356枚TSMNs,包括161例患者186枚乳头状甲状腺微小癌(PTMC)和142例患者170枚实性微小结节性甲状腺肿(SMNG)。将TSMNs的超声征象分为主要征象和次要征象,并赋予不同积分。采用受试者操作特性(ROC)曲线评价超声积分诊断PTMC的价值。结果根据ROC曲线,随着超声积分的增加,超声积分诊断PTMC的敏感度降低,特异度和阳性预测值增高。超声积分≥11.5分时超声积分诊断PTMC的特异度和阳性预测值均为100%,即甲状腺结节超声积分≥11.5分时即可确诊为PTMC;超声积分诊断PTMC的阴性预测值在超声积分≥1.5分时最大,为93.4%。以超声积分≥5.5分(即至少含1个主要征象)为诊断阈值,此时超声积分诊断PTMC的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为86.0%、81.8%、84.0%、83.8%、84.2%。结论超声积分能对TSMNs进行量化分析,对TSMNs诊断与鉴别诊断及指导临床治疗具有重要的价值。
Objective To explore the value of ultrasonic scores in diagnosis and differential diagnosis of thyroid solid micro-nodules（TSMNs）. Methods From January 2009 to June 2013, 356 TSMNs with surgical pathology in 303 patients at Hangzhou First People′ s Hospital were collected into the study, including 186 papillary thyroid micro carcinomas（PTMCs） in 161 patients and 170 solid micro nodular goiters（SMNGs） in 142 patients. The ultrasonic features of TSMNs are divided into the main feature and the secondary features, which are assigned with different scores. Receiver operating characteristic（ROC） curve is adopted to evaluate the diagnostic value of ultrasonic scores in PTMC. Results According to the ROC curve of ultrasonic scores in PTMC diagnosis, the sensitivity decrease while the specificity and positive predictive value increase along with the increment of scores. When the scores was ≥ 5.5, the sensitivity, specificity, positive predictive value and accuracy were 0.860, 0.818, 83.8%, and 84.0% respectively. When the scores are ≥ 11.5, specificity and positive predictive value were both 100%. When the scores ≥ 1.5, the negative predictive value was 93.4%. Conclusion Ultrasonic scores can quantitatively analyze the TSMNs, which has a significance in improving the clinical diagnosis and guiding treatment.
出处
《中华医学超声杂志（电子版）》
2014年第8期56-60,共5页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
2010年杭州市医药卫生科技计划项目(2010A001)
2012年杭州市卫生科技计划项目(2012A020)
2013杭州市重大科技创新专项项目(20131813A08)
