Department of Diagnostic Radiology, The Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea.
Clin Imaging. 2010 Mar-Apr;34(2):127-33. doi: 10.1016/j.clinimag.2008.10.034.
The purpose of this study was to assess the positive predictive value of the suspicious sonographic features of solid nodules of the thyroid.
After approval by our institutional review board, we evaluated 594 sonographically detected nodules on which fine needle aspiration biopsy had been performed from January to December 2005. Among these, pure cystic lesions and inadequate pathologic results were excluded. The remaining 530 solid thyroid nodules were analyzed by two radiologists. Each lesion was classified based on four sonographic features that suggested malignancy: microcalcifications; an irregular or microlobulated margin; marked hypoechogenicity; and a shape that was taller than wide. The sensitivity, specificity, positive predictive value, and negative predictive value of the each sonographic feature were calculated.
Final pathologic results showed that 97 (18.3%) of 530 nodules were malignant. The positive predictive values for malignancy in each sonographic feature were microcalcifications, 38.6% (39/101); an irregular or microlobulated margin, 28.2% (70/248); marked hypoechogenecity, 49.4% (38/77); taller than wide shape, 59.8% (49/82). In terms of relative risk, microcalcification [P<.01, relative risk (RR)=3.115, 95% CI: 1.724-5.628], hypoechogenecity (P<.01, RR=2.510, 95% CI: 1.290-4.881). The shape of nodule which was taller than wide (P<.01, RR=7.624, 95% CI: 4.156-13.986) revealed the highest predictive sonographic finding suggesting malignancy. However, margin is the least significant feature of detection of thyroid malignancy (P=.27, RR=1.395, 95% CI: 0.777-2.505).
The three sonographic features of solid thyroid nodule, that is, microcalcifications, marked hypoechogenecity, and a taller than wide shape are meaningful findings in the diagnosis of thyroid malignancy. The shape that was taller than wide was the most reliable sonographic feature for predicting malignancy.
本研究旨在评估甲状腺实性结节的可疑超声特征的阳性预测值。
经机构审查委员会批准，我们回顾性分析了 2005 年 1 月至 12 月期间进行细针抽吸活检的 594 个超声检测到的甲状腺结节。排除纯囊性病变和不充分的病理结果。由两名放射科医生对其余 530 个甲状腺实性结节进行分析。根据四个提示恶性的超声特征对每个病灶进行分类：微钙化；不规则或微小分叶状边缘；明显低回声；以及高宽比大于 1 的形状。计算每个超声特征的敏感性、特异性、阳性预测值和阴性预测值。
最终病理结果显示 530 个结节中有 97 个（18.3%）为恶性。每个超声特征的恶性肿瘤阳性预测值分别为微钙化 38.6%（39/101）；不规则或微小分叶状边缘 28.2%（70/248）；明显低回声 49.4%（38/77）；高宽比大于 1 的形状 59.8%（49/82）。就相对风险而言，微钙化[P<.01，相对风险（RR）=3.115，95%置信区间：1.724-5.628]，低回声（P<.01，RR=2.510，95%置信区间：1.290-4.881）。高宽比大于 1 的结节形状（P<.01，RR=7.624，95%置信区间：4.156-13.986）显示出最高的预测超声发现恶性肿瘤的特征。然而，边缘是检测甲状腺恶性肿瘤最不重要的特征（P=.27，RR=1.395，95%置信区间：0.777-2.505）。
甲状腺实性结节的三个超声特征，即微钙化、明显低回声和高宽比大于 1 的形状，对甲状腺恶性肿瘤的诊断具有重要意义。高宽比大于 1 的形状是预测恶性肿瘤最可靠的超声特征。
