摘要
本研究旨在开发一个简单易推广的预测甲状腺乳头状癌（PTC）的风险评估量表（量表），并比较该量表与甲状腺细针穿刺细胞学检查（FNAC）的诊断效能，以优化PTC的初筛流程。选择1 003例年龄11-82岁经手术治疗的甲状腺结节患者为研究对象，经logistic回归分析构建量表，并采用受试者工作特征曲线（ROC）评价其诊断效能、最佳诊断切点及恶性危险分层。采用诊断试验评价指标和曲线下面积（AUC）来比较FNAC、量表及两者联合诊断的诊断效能。量表中包括年龄、促甲状腺激素（TSH）、触诊结节形态、边界、超声下结节性质、形态、边界、钙化形态及结节内血流信号，AUC为0.815，6分为最佳良恶性鉴别切点，危险分层：≥9分为极高危，5-8分为高危，3-4分为中危，≤2分为低危。FNAC诊断PTC的灵敏度86.3%、特异度90.0%、准确性87.0%，AUC 0.891；量表诊断PTC的灵敏度83.8%、特异度70.0%、准确性81.0%，AUC 0.822；两者联合诊断的灵敏度97.5%，特异度85.0%，准确性95.0%，AUC 0.965。该量表可作为甲状腺结节患者行FNAC前的筛查手段，与FNAC联合可提高PTC的诊断效能，从而可能减少不必要的有创操作、手术治疗和费用。
To develop a simple and easy promotion risk score to identify individuals with undiagnosed papillary thyroid carcinoma （ PTC ） , and further to compare the diagnostic efficiency of PTC risk sore with fine needle aspiration cytodiagnosis （FNAC）. in order to optimize the screening process of PTC. A sample of 1 003 individuals aged 11-82 years underwent a surgical treatment of thyroid nodule participated in the study. The risk score was developed by stepwise backward multiple logistic regression. And using the receiver operating characteristic （ ROC ） curve to evaluate the diagnostic efficacy, the best diagnostic cut-off point and the risk stratification of malignant. Compare the sensitivity, specificity, accuracy, and area under curve （AUC） of PTC risk score, FNAC and their combined diagnosis to judge their diagnostic efficiency. The risk score included age, TSH, nodule morphology and boundary by palpation, nodule characteristics, shape, boundary, calcification and blood flow signal by ultrasound. Its AUC=0. 815, 6 point was the best cutoff point to differentiate benign from malignant thyroid nodules, and risk stratification of thyroid carcinoma were divided into four levels ： very high risk group （ score I〉 9 points）, high risk group （ score were 5-8 points ）, moderate risk group （ score were 3 - 4 points ）, low risk group （ score -〈 2 points）. The sensitivity, specificity, and accuracy of FNAC were 86.3%, 90.0%, and 87.0% respectively, AUC = 0.891, while the sensitivity, specificity, and accuracy of PTC risk rating scale were 83.8%, 70.0%, and 81.0% respectively, AUC = 0. 822. The sensitivity, specificity, and accuracy of their combined diagnosis were 97.5% , 85.0% , and 95.0% , AUC =0. 965. This risk score can be used as a screening method before FNAC. If combined with FNAC, it may improve the diagnostic efficacy of PTC, and thereby possibly minimizing the unnecessary invasive examination and surgical treatment for patients with thyroid nodules and reducing personal costs.
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2017年第9期755-759,共5页
Chinese Journal of Endocrinology and Metabolism
