Liu J F, Chen Y X, Zheng Y J, Wen D H, Wang Y C, Xue G
Department of Ultrasonography, the First Affiliated Hospital of Hebei North University, Zhangjiakou, 075000, China.
Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Hebei North University.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Sep;32(18):1400-1405. doi: 10.13201/j.issn.1001-1781.2018.18.009.
To evaluate the diagnostic value of the ATA (2015) ultrasound model, shear wave elastography (SWE), and ATA (2015)+SWE combinative modality for the diagnostic efficiency in thyroid nodules with Bethesda Classification Ⅲ indeterminate cytology, determine the diagnostic value of ultrasonography in Bethesda Classification Ⅲ indeterminate cytology.216 thyroid nodules that were initially diagnosed as AUS/FLUS by fine needle aspiration (FNA) were included in this study. The clinical data and two-dimensional ultrasonographic features were compared between the benign and malignant nodules. The two-dimensional ultrasound images of all nodules were sorted by the 2015ATA guideline ultrasound model grading criteria. The maximum and average shear wave velocity (SWV) values were obtained from multiple SWV measurement under the VTIQ speed mode. The optimal threshold drawing from ROC curve and diagnostic performance of single and combinative modality were calculated.①There was no significant difference in age, sex and nodule size between benign and malignant nodules (>0.05). Malignant nodules of 152 cases of AUS thyroid nodules had significantly higher rates of not well-circumscribed margin and presence of microcalcifications (=0.005,=0.004). ②There were significant differences in malignancy risk among the different US patterns defined by the 2015 ATA guidelines in AUS nodules. ③The maximum and mean SWV of AUS/FLUS nodules measured in VTIQ mode were statistically significant in evaluating benign and malignant nodules. ④The area under ROC curves of ATA (2015)+SWE combined mode was 0.912, larger than single diagnosis mode ［ATA (2015):0.854, SWE: 0.862］.SWE can not only compensate for the deficiency of ATA (2015) in the diagnosis of benign and malignant FLUS thyroid nodules, but also effectively improve the diagnostic performance of ATA (2015) in the differentiation of benign and malignant AUS thyroid nodules.
为评估美国甲状腺学会（ATA，2015年）超声模型、剪切波弹性成像（SWE）以及ATA（2015年）+SWE联合模式对甲状腺结节细针穿刺活检（FNA）结果为贝塞斯达分类Ⅲ类意义不明确的诊断效能，确定超声检查在贝塞斯达分类Ⅲ类意义不明确中的诊断价值。本研究纳入216个最初经FNA诊断为不典型鳞状细胞/意义不明确的滤泡性病变（AUS/FLUS）的甲状腺结节。比较良恶性结节的临床资料及二维超声特征。所有结节的二维超声图像按照2015年ATA指南超声模型分级标准进行分类。在虚拟触诊组织定量（VTIQ）速度模式下，通过多次测量剪切波速度（SWV）获得最大和平均SWV值。计算从ROC曲线得出的最佳阈值以及单一和联合模式的诊断性能。①良恶性结节在年龄、性别和结节大小方面无显著差异（>0.05）。152例AUS甲状腺结节中的恶性结节边界不清和存在微钙化的发生率显著更高（=0.005，=0.004）。②2015年ATA指南定义的不同超声模式在AUS结节中的恶性风险存在显著差异。③在VTIQ模式下测量的AUS/FLUS结节的最大和平均SWV在评估良恶性结节方面具有统计学意义。④ATA（2015年）+SWE联合模式的ROC曲线下面积为0.912，大于单一诊断模式［ATA（2015年）：0.854，SWE：0.862］。SWE不仅可以弥补ATA（2015年）在诊断FLUS甲状腺结节良恶性方面的不足，还能有效提高ATA（2015年）在鉴别AUS甲状腺结节良恶性方面的诊断性能。
