准静态超声弹性成像在甲状腺结节诊断中的诊断准确性及观察者间一致性
Diagnostic accuracy and interobserver agreement of Quasistatic Ultrasound Elastography in the diagnosis of thyroid nodules.
作者信息
Cantisani V, Lodise P, Di Rocco G, Grazhdani H, Giannotti D, Patrizi G, Medvedyeva E, Olive M, Fioravanti C, Giacomelli L, Chiesa C, Redler A, Catalano C, D'Ambrosio F, Ricci P
机构信息
Department of Radiology, "Sapienza" University of Rome, Rome, Italy.
Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy.
出版信息
Ultraschall Med. 2015 Apr;36(2):162-7. doi: 10.1055/s-0034-1366467. Epub 2014 Jun 23.
PURPOSE
To assess the best technique and the diagnostic accuracy of Quasistatic Ultrasound Elastography (QUE) in thyroid nodules. Interobserver agreement was also evaluated.
MATERIALS AND METHODS
A preliminary study of 50 patients with 54 thyroid nodules was performed with quantitative software in order to define the best cut-off value of different imaging methods. All patients underwent total thyroidectomy and histopathology findings served as the standard of reference. Thereafter, 154 nodules in 137 consecutive patients were prospectively evaluated by three operators. Findings at fine-needle aspiration cytology and histopathology (N = 60) served as the standard of reference.
RESULTS
The most accurate technique was the axial peri-intranodular measurement method which achieved an area under the ROC curve of 0.961 (95 %CI 0.848 - 1.00) and had an optimal cut-off value of 3.00. QUE in the differentiation of thyroid nodules showed for operator 1: sensitivity 90 % (95 %CI 73.5 - 97.9 %), specificity 92.7 % (95 %CI 86.7 - 96.6 %), LR+ 12.40 (6.54 - 23.50), LR- 0.11 (0.04 - 0.32) and accuracy 91.4 % (95 %CI 85.4 - 97.3 %); for operator 2: sensitivity 86.7 % (95 %CI 69.3 - 96.2 %), specificity 87.1 % (95 %CI 79.9 - 92.4 %), LR+ 6.72 (4.16 - 10.80), LR- 0.15 (0.06 - 0.38) and accuracy 86.9 % (95 %CI 80.0 - 93.7 %); for operator 3: sensitivity 80 % (95 %CI 61.4 - 92.3 %), specificity 83.9 % (95 %CI 76.2 - 89.9 %), LR+ 4.96 (3.20 - 7.70), LR- 0.24 (0.12 - 0.49) and accuracy 81.9 % (95 %CI 74.0 - 89.9 %). Interobserver agreement values between operator 1 and operator 2 (k = 0.79) (p < 0.05, 95 %CI 0.684 - 0.904), between operator 1 and operator 3 (k = 0.73, 95 %CI: 0.607 - 0.854) and between operator 2 and operator 3 (k = 0.71, 95 %CI: 0.584 - 0.835) were significant.
CONCLUSION
QUE provides accurate quantitative evaluation of thyroid nodules with low interobserver variability.
目的
评估准静态超声弹性成像（QUE）在甲状腺结节中的最佳技术及诊断准确性。同时评估观察者间的一致性。
材料与方法
对50例患者的54个甲状腺结节进行初步研究，使用定量软件确定不同成像方法的最佳截断值。所有患者均接受全甲状腺切除术，组织病理学结果作为参考标准。此后，由三名操作人员对137例连续患者的154个结节进行前瞻性评估。细针穿刺细胞学检查和组织病理学检查结果（N = 60）作为参考标准。
结果
最准确的技术是轴位结节内周边测量法，其ROC曲线下面积为0.961（95%CI 0.848 - 1.00），最佳截断值为3.00。QUE在甲状腺结节鉴别诊断中，操作人员1的结果为：敏感性90%（95%CI 73.5 - 97.9%），特异性92.7%（95%CI 86.7 - 96.6%），阳性似然比12.40（6.54 - 23.50），阴性似然比0.11（0.04 - 0.32），准确性91.4%（95%CI 85.4 - 97.3%）；操作人员2的结果为：敏感性86.7%（95%CI 69.3 - 96.2%），特异性87.1%（95%CI 79.9 - 92.4%），阳性似然比6.72（4.16 - 10.80），阴性似然比0.15（0.06 - 0.38），准确性86.9%（95%CI 80.0 - 93.7%）；操作人员3的结果为：敏感性80%（95%CI 61.4 - 92.3%），特异性83.9%（95%CI 76.2 - 89.9%），阳性似然比4.96（3.20 - 7.70），阴性似然比0.24（0.12 - 0.49），准确性81.9%（95%CI 74.0 - 89.9%）。操作人员1与操作人员2之间（k = 0.79）（p < 0.05，95%CI 0.684 - 0.904）、操作人员1与操作人员3之间（k = 0.73，95%CI：0.607 - 0.854）以及操作人员2与操作人员3之间（k = 0.7l，95%CI：0.584 - 0.835）的观察者间一致性值具有显著性。
结论
QUE对甲状腺结节提供了准确的定量评估，观察者间变异性较低。
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