超声造影目标穿刺对直径≥10mm甲状腺乳头状癌的诊断价值

Diagnostic value of contrast-enhanced ultrasound targeted puncture for papillary carcinoma of the thyroid with a diameter of≥10 mm

傅庆印 ¹刘启平 ¹赵宜凡 ¹杨通辉 ¹胡滨¹

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作者信息

1. 复旦大学附属闵行医院超声科,上海 201199
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摘要

目的:研究超声造影(contrast-enhanced ultrasound,CEUS)引导下细针穿刺活检(fine-needle aspiration biopsy,FNAB)对直径≥10 mm甲状腺乳头状癌(papillary carcinoma of the thyroid,PTC)的诊断价值.方法:回顾并分析2020年5月—2023年8月复旦大学附属闵行医院经术后病理学检查证实的PTC(直径≥10 mm)患者资料.所有患者均先行CEUS检查,CEUS结束后在结节最大径线的二维超声图像下行常规超声引导下FNAB(US-FNAB),抽吸细胞组织涂片2张(标注A1、A2)作为常规穿刺组.观察同一结节CEUS时图像,选取结节灌注区域行目标穿刺,抽吸细胞组织涂片2张(标注B1、B2)作为目标穿刺组.以术后病理学检查结果为金标准,采用一致性Kappa检验分析CEUS、US-FNAB以及CEUS-FNAB这3种方法对PTC的诊断价值.结果:本研究共纳入149例患者(155个结节),在诊断155个PTC方面,CEUS诊断PTC的灵敏度、特异度、准确度分别为87.1%、68.6%、83.2%;US-FNAB诊断PTC的灵敏度、特异度、准确度分别为92.9%、78.0%、85.6%;CEUS-FNAB诊断PTC的灵敏度、特异度、准确度分别为98.1%、79.6%、94.9%.以术后病理学检查结果为金标准,CEUS结果与术后病理学检查结果行Kappa一致性检验,Kappa=0.393(Kappa＜0.4),一致性较差,差异有统计学意义(P＜0.01);US-FNAB结果的Kappa值=0.574(0.75＞Kappa≥0.4),一致性一般,差异有统计学意义(P＜0.01);CEUS-FNAB结果的Kappa值=0.773(Kappa＞0.75),一致性较好,差异有统计学意义(P＜0.01).结论:CEUS技术有助于发现甲状腺的可疑病灶,CEUS-FNAB可提升穿刺准确度和病灶检出率,对PTC的诊断具有重要意义.

Abstract

Objective:To investigate the diagnostic value of contrast-enhanced ultrasound(CEUS)guided fine-needle aspiration biopsy(FNAB)for papillary thyroid carcinoma of the thyroid(PTC)with a diameter of≥10 mm.Methods:The data of patients with PTC(≥10 mm in diameter)confirmed by postoperative pathology from May 2020 to August 2023 in Minhang Hospital of Fudan University were reviewed and analyzed.All nodules were first examined by CEUS.After the CEUS,conventional ultrasound-guided FNAB(US-FNAB)was performed to the two-dimensional ultrasound image of the largest diameter of the nodule.Two tissue smears(labeled A1 and A2)were used as conventional puncture group.For the same nodule,CEUS images of the same nodule were observed,and the perfused area of the nodule was selected for target puncture,and 2 aspirated cell tissue smears(labeled B1 and B2)as the target puncture group.With the postoperative pathological findings as the gold standard,the diagnostic value of CEUS,US-FNAB and CEUS-FNAB for PTC was analyzed using the consistency Kappa test.Results:A total of 149 patients(155 nodes)were included in this study.The sensitivity,specificity and accuracy of CEUS in diagnosing 155 PTCs were 87.1%,68.6%and 83.2%,respectively;the sensitivity,specificity and accuracy of US-FNAB were 92.9%,78.0%and 85.6%;and the sensitivity,specificity and accuracy of CEUS-FNAB were 98.1%,79.6%and 94.9%,respectively.With the postoperative pathology results as the gold standard,Kappa consistency test was performed between the CEUS results and the postoperative pathology results,with Kappa=0.393(Kappa＜0.4),poor consistency,and statistically significant difference(P＜0.01);the Kappa value of the US-FNAB results=0.574(0.75＞Kappa≥0.4),the consistency was fair,and the difference was statistically significant(P＜0.01);Kappa value of CEUS-FNAB results=0.773(Kappa＞0.75),consistency was good,and the difference was statistically significant(P＜0.01).Conclusion:CEUS technology is helpful to detect suspicious lesions of thyroid cancer,and CEUS-FNAB can improve the accuracy of puncture and lesion detection rate,which is of great significance for the diagnosis of PTC.

关键词

甲状腺乳头状癌/超声/细针穿刺活检/超声造影

Key words

Papillary carcinoma of the thyroid/Ultrasound/Fine-needle aspiration biopsy/Contrast-enhanced ultrasound

引用本文复制引用

出版年

2024

肿瘤影像学

复旦大学附属肿瘤医院

肿瘤影像学

CSTPCD

影响因子：0.67

ISSN：1008-617X

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