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目的:探讨弹性超声评分法在甲状腺结节良恶性鉴别中的诊断价值,分析产生误诊、漏诊的原因,以提高对甲状腺病变的诊断水平。方法:本研究采用回顾性分析方法,收集59个病例共计85个甲状腺结节,根据手术病理结果将85个结节分为良性组[42人,年龄13~74岁,平均(53.16±13.00)岁,63个结节]和恶性组[17人,年龄24~68岁,平均(44.77±11.51)岁,22个结节]。分析弹性超声图像,统计组间弹性评分差异;勾画受试者工作曲线,评估弹性评分方法的鉴别诊断效能;计算截断点,提高诊断甲状腺恶性结节的诊断敏感性和特异性。结果:甲状腺良恶性结节组间弹性评分有显著差异(非参数Mann-Whitney秩和检验,Z=-9.517,P=0.000<0.05);受试者工作曲线下面积为0.886(P=0.000<0.05),具有较高的鉴别诊断能力;弹性评分≥3分(截断点=3),诊断恶性甲状腺结节的特异性为77.3%,敏感性为85.7%,约登指数为0.63。结论:弹性超声评分法有助于提高甲状腺结节良恶性的鉴别诊断,但多种因素仍能导致误诊、漏诊发生,需要结合实际情况综合判断。
Objective: To investigate the diagnostic value of elastic ultrasonic scoring method in benign and malignant thyroid nodules, and to analyze the causes of misdiagnosis and missed diagnosis in order to improve the diagnosis of thyroid lesions. Methods: A total of 85 thyroid nodules were collected from 59 cases in this study. According to the pathological findings, 85 nodules were divided into benign group [42 persons, aged 13-74 years (mean, 53.16 ± 13.00) Year old, 63 nodules] and malignant group [17 persons, aged 24-68 years, mean (44.77 ± 11.51) years, 22 nodules]. Analysis of elastic ultrasound images, statistical differences between groups of elastic score; outline the working curve of the subjects to assess the effectiveness of the elastic scoring method of differential diagnosis efficacy; calculated cut-off point to improve the diagnostic sensitivity and specificity of the diagnosis of malignant thyroid nodules. Results: There was a significant difference in elasticity scores between benign and malignant thyroid nodules (non-parametric Mann-Whitney rank sum test, Z = -9.517, P = 0.000 <0.05); the area under the working curve was 0.886 (P = 0.000 < 0.05), with high differential diagnostic ability; elasticity score ≥ 3 points (cut-off point = 3), the specificity of diagnosis of malignant thyroid nodules was 77.3%, the sensitivity was 85.7% and the Youden index was 0.63. Conclusion: EUS can improve the differential diagnosis of benign and malignant thyroid nodules, but many factors can lead to misdiagnosis and missed diagnosis, which need to be combined with the actual situation.