甲状腺TI-RADS分类结合超声造影指导超声引导下细针穿刺细胞涂片在鉴别诊断甲状腺结节良恶性中的应用价值

Thyroid TI-RADS classification combined with contrast-enhanced ultrasound in ultrasound-guided fine needle aspiration cell smears for the identification and diagnosis of benign and malignant thyroid nodules

摘要:

目的： 探讨甲状腺TI-RADS分类结合超声造影指导超声引导下细针穿刺（fine needle aspiration，FNA）细胞涂片在鉴别诊断甲状腺结节良恶性中的应用价值。方法： 选择2018年6月至2020年2月在四川省科学城医院和成都医学院第一附属医院接受治疗的甲状腺结节患者1 038例进行研究。采用随机数字表法将患者分为2组，每组各519例。对照组行甲状腺TI-RADS分类指导FNA细胞涂片检查，观察组在此基础上加以超声造影检查。比较2组取材成功率及2种引导取材方式对甲状腺结节良恶性鉴别的诊断效能。结果： 观察组取材成功率为93.45%，高于对照组的75.34%（P<0.05）。甲状腺TI-RADS分类指导下FNA细胞涂片检测与组织病理学诊断一致性较差，Kappa值为0.365（P<0.05），诊断灵敏度、特异度、准确度分别为74.42%（64/86）、71.80%（219/305）、72.38%（283/391）。甲状腺TI-RADS分类联合超声造影指导下FNA细胞涂片检测与组织病理学诊断一致性良好，Kappa值为0.785（P<0.05），诊断灵敏度、特异度、准确度分别为91.80%（112/122）、90.63%（329/363）、90.93%（441/485）。观察组灵敏度、特异度及准确度均高于对照组（P<0.05）。结论： 甲状腺TI-RADS分类结合超声造影指导FNA细胞涂片鉴别良恶性甲状腺结节较单独使用甲状腺TI-RADS分类可有效提高取材成功率，该方法操作简便，诊断灵敏度、特异度、准确度均较高，有较大的临床推广价值。

Abstract:

Objective: To explore the application value of thyroid TI-RADS classification combined with ultrasound-guided fine needle aspiration (FNA) cell smear in the identification and diagnosis of benign and malignant thyroid nodules. Methods: A total of 1 038 patients with thyroid nodules who were treated in our hospital and The First Affiliated Hospital of Chengdu Medical College from June 2018 to February 2020 were selected in the study. Patients were randomly divided into 2 groups, with 519 patients in each group (control group and observation group). The control group underwent thyroid TI-RADS classification guided FNA cell smear examination, and the observation group underwent contrast-enhanced ultrasound examination on this basis. The success rate of the two groups of materials and the diagnostic efficiency of the two methods of guiding materials in the differentiation of benign and malignant thyroid nodules were compared. Results: The success rate of sampling in the observation group was 93.45%, which was higher than 75.34% in the control group (P<0.05). The consistency of FNA cell smear detection and histopathological diagnosis under the guidance of thyroid TI-RADS classification was poor, with Kappa value of 0.365 (P<0.05), and the diagnostic sensitivity, specificity and accuracy were 74.42% (64/86), 71.80% (219/305) and 72.38% (283/391), respectively. FNA cell smear detection and histopathological diagnosis under the guidance of thyroid TI-RADS classification combined with contrast-enhanced ultrasound were in good agreement with histopathological diagnosis, with Kappa value of 0.785 (P<0.05), and the diagnostic sensitivity, specificity and accuracy were 91.80% (112/122), 90.63% (329/363) and 90.93% (441/485), respectively. The sensitivity, specificity and accuracy of the observation group were higher than those of the control group (P<0.05). Conclusion: Thyroid TI-RADS classification combined with contrast-enhanced ultrasound to guide FNA cell smears can effectively improve the success rate of identifying benign and malignant thyroid nodules compared with thyroid TI-RADS classificationalone. This method is simple to operate with higher diagnostic sensitivity, specificity and accuracy, and of great clinical value.