The Department of Otolaryngology in the Zhongshan City People's Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, People's Republic of China.
The Department of Radiology in the Zhongshan City People's Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, People's Republic of China.
Technol Cancer Res Treat. 2020 Jan-Dec;19:1533033820948183. doi: 10.1177/1533033820948183.
The present study was designed to investigate the presence or absence of calcification and whether calcification size affect the diagnostic accuracy of ultrasonography (US) and computed tomography (CT) in predicting the benign or malignant nature of thyroid nodules.
From May 2014 to April 2019, 445 patients underwent thyroid US and neck CT before thyroid surgery. In each case, US and CT were retrospectively examined by radiologists. We divided the patients into 3 groups according to the type of calcification: no calcification, microcalcification, and macrocalcification. And macrocalcification group divided into rim calcifications and non-rim calcifications groups. We evaluated the diagnostic accuracy of US and CT for differentiating malignant from benign thyroid nodules using histopathological results as a reference standard.
In the overall population, adding CT to US resulted in greater sensitivity, lower specificity, and lower accuracy in the prediction of the benign or malignant nature of nodules. In the group with no calcification, US had a significantly greater accuracy than CT and combined US/CT. In the group with macrocalcification, especially in rim calcifications, adding CT to US resulted in greater sensitivity than US, and CT exhibited greater sensitivity and accuracy than US.
US is superior to CT for the prediction of the benign or malignant nature of nodules in thyroid lesions according to calcification and CT is also currently not recommended as a routine imaging tool for thyroid nodules. However, the superior sensitivity and accuracy of CT in lesions with macrocalcification especially in rim calcifications may enable CT to play a complementary role in identifying benign and malignant nodules.
本研究旨在探讨甲状腺结节内是否存在钙化以及钙化大小是否影响超声（US）和计算机断层扫描（CT）对甲状腺结节良恶性的诊断准确性。
2014 年 5 月至 2019 年 4 月，445 例甲状腺手术患者行甲状腺 US 和颈部 CT 检查。每位患者的 US 和 CT 图像均由放射科医生进行回顾性分析。我们根据钙化类型将患者分为 3 组：无钙化、微钙化和粗钙化。粗钙化组又分为边缘钙化和非边缘钙化组。我们根据组织病理学结果作为参考标准，评估 US 和 CT 对区分甲状腺良恶性结节的诊断准确性。
在总体人群中，与 US 相比，CT 联合 US 可提高良恶性甲状腺结节的诊断灵敏度，降低特异性和准确性。在无钙化组中，US 的准确性显著高于 CT 和联合 US/CT。在粗钙化组中，特别是在边缘钙化中，CT 联合 US 较 US 可提高诊断灵敏度，CT 比 US 具有更高的灵敏度和准确性。
根据钙化情况，US 对甲状腺病变良恶性的预测优于 CT，目前也不建议 CT 作为甲状腺结节的常规影像学检查手段。然而，在伴有粗钙化，特别是边缘钙化的病变中，CT 具有更高的灵敏度和准确性，可能使 CT 在识别良恶性结节方面发挥补充作用。
