Liu Yingchun, Liu Hui, Zhan Jia, Chai Qiliang, Zhu Jun, Ding Shengnan, Chen Lin
Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.
Department of Ultrasound, Shanghai Cancer Center, Fudan University, Shanghai, China.
Clin Endocrinol (Oxf). 2025 Feb;102(2):223-231. doi: 10.1111/cen.15160. Epub 2024 Nov 6.
A small number of thyroid nodules cannot be clearly diagnosed using ultrasound-guided fine needle aspiration biopsy. Contrast-enhanced ultrasound (CEUS) has high diagnostic performance for thyroid nodules. We explored the value of CEUS for diagnosing thyroid nodules with indeterminate cytology.
Between September 2019 and July 2022, 27,646 patients with thyroid nodule(s) underwent conventional ultrasound (CUS) in our hospital. From these patients, 597 nodules were subjected to CEUS and ultrasound-guided fine needle aspiration biopsy and 116 thyroid nodules with indeterminate cytology diagnose were enrolled in this study. The independent risk factors for predicting malignancy were determined using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were drawn for CUS, CEUS, and CEUS combined with CUS. The area under the curve (AUC) was calculated and compared.
Of the 116 thyroid nodules, 40 (34.5%) were benign and 76 (65.5%) were malignant. Univariate analysis showed that the shape, echogenicity, margin, microcalcification, enhancement intensity, enhancement homogeneity, wash in, and wash out were significantly different between benign and malignant thyroid nodules (all p < 0.05). Multivariate logistic regression analysis showed that taller-than-wide, irregular margin, microcalcification, hypo-enhancement, heterogeneity enhancement, synchronous/slower wash in, and synchronous/slower wash out were independent risk factors for malignancy (all p < 0.05). ROC curve analysis showed that the AUC of CUS and CEUS were 0.769 and 0.848, respectively. No significant difference was observed in the AUC between the two modalities (p > 0.05). However, the AUC (0.934) of the CUS combined with CEUS was significantly higher than that of CEUS or CUS alone (both p < 0.05).
CEUS is helpful in diagnosing thyroid nodules with indeterminate cytology. CUS combined with CEUS is highly valuable for predicting malignancy.
少数甲状腺结节无法通过超声引导下细针穿刺活检明确诊断。超声造影（CEUS）对甲状腺结节具有较高的诊断性能。我们探讨了CEUS在诊断细胞学结果不确定的甲状腺结节中的价值。
2019年9月至2022年7月期间，我院27646例甲状腺结节患者接受了常规超声（CUS）检查。从这些患者中，597个结节接受了CEUS和超声引导下细针穿刺活检，116个细胞学诊断结果不确定的甲状腺结节纳入本研究。采用单因素和多因素逻辑回归分析确定预测恶性肿瘤的独立危险因素。绘制CUS、CEUS以及CUS联合CEUS的受试者操作特征（ROC）曲线。计算并比较曲线下面积（AUC）。
116个甲状腺结节中，40个（34.5%）为良性，76个（65.5%）为恶性。单因素分析显示，良性和恶性甲状腺结节在形态、回声、边界、微钙化、增强强度、增强均匀性、快进和快出方面存在显著差异（均p<0.05）。多因素逻辑回归分析显示，纵横比大于1、边界不规则、微钙化、低增强、不均匀增强、同步/缓慢快进和同步/缓慢快出是恶性肿瘤的独立危险因素（均p<0.05）。ROC曲线分析显示，CUS和CEUS的AUC分别为0.769和0.848。两种检查方式的AUC之间未观察到显著差异（p>0.05）。然而，CUS联合CEUS的AUC（0.934）显著高于单独的CEUS或CUS（均p<0.05）。
CEUS有助于诊断细胞学结果不确定的甲状腺结节。CUS联合CEUS对预测恶性肿瘤具有很高的价值。
