Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China.
Clin Hemorheol Microcirc. 2020;74(3):255-266. doi: 10.3233/CH-180533.
The aim of this study was to evaluate the diagnostic value of conventional sonography and ultrasound elastography for thyroid nodules of each Bethesda category and to analyze their potential role in the corresponding management decision.
This retrospective study included 557 thyroid nodules diagnosed by conventional ultrasound (US) and real-time ultrasound elastography (RTE) before fine-needle aspiration (FNA) from 458 patients. The US, RTE, and cytological results were collected and analyzed according to different Bethesda categories. Differences in the distribution of sonographic features between groups were evaluated by the Chi-square test or Fisher exact test. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of conventional US and RTE for the diagnosis of malignant nodules in each category were then calculated and analyzed.
The diagnostic accuracy of the comprehensive US diagnosis in all categories stayed at a relatively high level from 78.4% to 88.6%, and good specificities ranging from 77.3% to 100% were revealed in all Bethesda categories. As to RTE, the diagnostic accuracies in categories I-IV stayed at a relatively low level ranging from 44.6% to 65.6% except for better performance in categories V and VI (85.2%, 89.1%). Besides, the accuracies of comprehensive US (85.2%, 88.6%) and RTE (85.2%, 89.1%) is relatively low compared to the corresponding cytological diagnoses in categories V and VI.
Conventional US is complementary to FNA for providing additional hints especially in categories I-IV for further clinical managements, while RTE failed to provide useful diagnostic information in general.
本研究旨在评估常规超声和超声弹性成像对每个 Bethesda 分类甲状腺结节的诊断价值，并分析其在相应管理决策中的潜在作用。
本回顾性研究纳入了 458 例患者的 557 个经常规超声（US）和实时超声弹性成像（RTE）诊断的甲状腺结节，这些患者均接受了细针抽吸活检（FNA）。根据不同的 Bethesda 分类收集和分析 US、RTE 和细胞学结果。通过卡方检验或 Fisher 确切概率法评估组间超声特征分布差异。然后计算并分析常规 US 和 RTE 对各分类恶性结节的诊断准确性。
综合 US 诊断在所有分类中的诊断准确率保持在较高水平，为 78.4%至 88.6%，且所有 Bethesda 分类的特异性均较好，范围为 77.3%至 100%。对于 RTE，I-IV 类的诊断准确率相对较低，范围为 44.6%至 65.6%，除 V 和 VI 类外（85.2%，89.1%）表现较好。此外，综合 US（85.2%，88.6%）和 RTE（85.2%，89.1%）的准确率相对较低，与 V 和 VI 类相应的细胞学诊断相比。
常规 US 可补充 FNA，为进一步的临床管理提供额外的提示，尤其是在 I-IV 类，而 RTE 通常无法提供有用的诊断信息。
