剪切波弹性成像技术联合2015版美国甲状腺学会指南在甲状腺结节中的临床价值

发布时间：2018-06-19 13:04

本文选题：甲状腺结节 + 2015版ATA指南　；参考：《郑州大学》2017年硕士论文

【摘要】：背景与目的随着高频超声技术的快速发展,甲状腺结节的检出率也随之提高,有资料显示,在随机调查的人群中,被检出的甲状腺结节约为19%—67%,其中甲状腺恶性结节约占为5%—10%。为规范甲状腺结节的诊断与治疗,2015年,美国甲状腺学会(American Thyroid Association,ATA)颁布了新版的指南。其因甲状腺结节二维超声特征的不同将其分为5个风险系数不同的组别,如下:1、良性(1%);2、极低度可疑恶性组(3%);3、低度可疑恶性组(5%~10%);4、中度可疑恶性组(10%~20%),5、高度可疑恶性组(70%~90%)。然而ATA指南中,尚有部分结节未包含其中,定为“未描述组”。ATA指南推荐低度、中度、高度可疑恶性组行细针抽吸(fine-needle aspiration,FNA)活检,然而甲状腺良恶性结节的超声图像特征交叉和多变,良恶性结节之间存在相似的超声声像图表现,并且由于不同的超声医生诊断经验的不同,对相同的结节可能给予不同风险类别,因此需要另一些检查手段对其进一步分类处理。剪切波弹性(SWE)成像技术能直观反映组织的硬度信息,定量评价结节良恶性。本研究旨在探讨SWE成像技术,2015版ATA联合SWE成像技术在甲状腺结节良恶性方面的临床价值,探讨SWE成像技术能否提高ATA指南的诊断效能,使一些良性结节免于FNA穿刺检查,从而使ATA在临床应用中,能够更针对性的进行FNA。资料与方法1.第一部分,收集2015年10月至2016年9月来我院就诊,经超声发现甲状腺结节175例,均行剪切波弹性成像检查,测量每个结节杨氏模量最大值,以术后病理结果为金标准,得出鉴别甲状腺良恶性结节的最佳界值。2.第二部分,评价ATA指南对甲状腺结节的诊断效能。将极低可疑恶性组的结节定为良性,低度可疑恶性组以及以上组别(包括未描述组)的定为恶性,得出ATA指南诊断甲状腺良恶性结节的敏感度,特异度及准确度;利用第一部分鉴别良恶性结节的最佳界值,将低度、中度可疑恶性组及未描述组中大于等于界值的诊断为恶性,低于界值诊断为良性,余不变。得出应用SWE技术后,ATA指南诊断良恶性结节的敏感度,特异度及准确度。比较两种方法之间敏感度,特异度及准确度之间的差异。结果1.本研究的175例结节中,良性结节82例,恶性结节93例,良性结节的Emax为39.94±24.45Kpa,恶性结节的Emax为79.91±31.79Kpa,恶性结节Emax良性结节Emax,差异有统计学意义(P0.05)。绘制结节最大杨氏模量值的ROC曲线,得出AUC为0.821,其诊断良恶性结节的最佳界值为53.53Kpa,敏感度为90.32%,特异度为80.49%,准确度为85.71%。2.单独应用ATA指南,其诊断甲状腺恶性结节的灵敏度为98.92%,特异度为32.93%,准确度为68.00%;SWE技术联合ATA指南后,其诊断良恶性结节的灵敏度为97.85%,特异度为79.36%,准确度为89.14%。两种诊断方法灵敏度之间的比较(P0.05),认为两种方法灵敏度之间的差异无统计学意义;特异度、准确度之间的比较(P0.05),认为两种方法特异度、准确度之间的差异有统计学意义。结论1.SWE成像技术能够定量评价结节的硬度信息,Emax诊断良恶性结节的最佳界53.53Kpa。2.鉴别甲状腺结节良恶性方面,SWE技术联合2015版ATA指南较单独应用ATA指南能够在不降低灵敏度同时,提高其特异度和准确度,从而能够更有针对性对结节行FNA穿刺。
[Abstract]:Background and objective with the rapid development of high frequency ultrasound technology, the detection rate of thyroid nodules is also increased. Some data show that the thyroid nodules are about 19% - 67% in the random survey population, and the thyroid malignant nodules are about 5% - 10%. for the diagnosis and treatment of thyroid nodular nodules, 2015, American thyroid American Thyroid Association (ATA) issued a new version of the guide. It was divided into 5 different groups of risk factors for thyroid nodule two-dimensional ultrasound characteristics, as follows: 1, benign (1%); 2, extremely low suspected malignant group (3%); 3, low-grade suspected malignant group (5%~10%); 4, moderately suspicious malignant group (10%~20%), 5, highly suspected malignant group (70%~9). 0%). However, in the ATA guide, there are still some nodules not included, and the "undescribed group".ATA guide recommends a low, moderate, and highly suspected malignant group with fine needle aspiration (fine-needle aspiration, FNA) biopsy. However, the ultrasonographic features of benign and malignant thyroid nodules are intersected and varied, and there is a similar ultrasonic image between benign and malignant nodules. The graphical representation, and the different diagnostic experiences of different doctors, may give different types of risk to the same nodules, and therefore need to be further classified by other means. The shear wave elasticity (SWE) imaging technique can directly reflect the organizational hardness information and quantify the nodules and malignancies. The aim of this study is to explore the SWE formation. Like technology, the clinical value of the 2015 version of ATA combined with SWE imaging technique in the benign and malignant thyroid nodules, explore whether SWE imaging technology can improve the diagnostic efficiency of the ATA guide, and make some benign nodules free from FNA puncture examination, so that in clinical application, ATA can be more targeted to the first part of the FNA. data and method 1., and collect the 2015 10. From month to September 2016 to our hospital, 175 cases of thyroid nodules were detected by ultrasound, all of them were examined by shear wave elastic imaging and measured the maximum Young's modulus of each nodule. The best boundary value.2. second for differentiating benign and malignant thyroid nodules was obtained by the postoperative pathological results as gold standard, and the diagnostic efficacy of the ATA guide for thyroid nodules was evaluated. The nodules of the extremely low and suspected malignant groups were benign, the lower suspected malignant group and the above group (including the undescribed group) were malignant, and the sensitivity, specificity and accuracy of the ATA guide for the diagnosis of thyroid benign and malignant nodules; the best boundary value of the first part to identify the benign and malignant nodules, the low, moderate, suspicious and malignant groups and undescribed groups were used. The diagnosis of the value greater than the boundary value was malignant, and the value below the boundary value was benign. The sensitivity, specificity and accuracy of the ATA guide for the diagnosis of benign and malignant nodules were obtained. The differences between the sensitivity, specificity and accuracy of the two methods were compared between the two methods. Results in the 1. studies, 175 cases of nodules, 82 cases of benign nodules, and malignant. There were 93 cases of nodules, Emax of benign nodules were 39.94 + 24.45Kpa, Emax of malignant nodules were 79.91 + 31.79Kpa, and malignant nodules were Emax benign nodules Emax. The difference was statistically significant (P0.05). The ROC curve of the maximum Young's modulus value was drawn, and AUC was 0.821. The best boundary value for the diagnosis of benign and malignant nodules was 53.53Kpa, the sensitivity was 90.32%, the specificity was the degree of specificity. 80.49%, the accuracy was 85.71%.2. alone with the ATA guide, the sensitivity of the diagnosis of thyroid malignant nodules was 98.92%, the specificity was 32.93%, and the accuracy was 68%; the sensitivity of the diagnosis of benign and malignant nodules was 97.85%, the specificity was 79.36%, and the accuracy of the 89.14%. two diagnostic methods was compared (P0.0). 5), the differences between the sensitivity of the two methods were not statistically significant; the specificity and accuracy were compared (P0.05), and the difference between the two methods and the accuracy was statistically significant. Conclusion 1.SWE imaging technique can quantitatively evaluate the hardness information of the nodules, and the best boundary of Emax for the diagnosis of benign and malignant nodules is 53.53Kpa.2. identification. In terms of benign and malignant adenoid nodules, the SWE technique combined with the 2015 edition of the ATA guide is more sensitive than the ATA guide, and improves its specificity and accuracy, so as to be more targeted to the nodules for FNA puncture.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R581

【参考文献】