摘要
目的:探讨超声联合增强CT(CECT)对经超声引导下细针穿刺(US-FNAB)细胞学检查结果为Bethesda Ⅰ、Ⅲ类甲状腺结节的诊断价值.方法:选取 2020 年 1 月—2023 年 4 月在贵州医科大学附属医院行US-FNAB检查诊断为Bethesda Ⅰ、Ⅲ类并取得手术病理结果的 184 名甲状腺结节患者,所有患者术前均行甲状腺超声及CECT检查.收集甲状腺结节的超声及CECT特征,测量甲状腺结节、周围腺体及颈部肌的动、静脉期CT值.根据甲状腺结节术后病理结果将患者分为良性组、恶性组,单因素分析良、恶性结节超声及CECT的特征,将经单因素分析差异有统计学意义的超声、CECT特征建立多因素二元Lo-gistic回归模型,模型 1 为超声组,模型 2 为CECT组,模型 3 为C-TIRADS分类组,模型 4 为模型 1+模型 2 联合诊断组,模型 5为模型 2+模型 3 联合诊断组.以甲状腺结节术后病理结果为金标准,构建ROC曲线、校准曲线和决策曲线,对模型的诊断性能进行比较.结果:良性组和恶性组间超声特征中结节最大径、结构、方位、边缘、边界、局灶性强回声、后方回声、包膜完整性及淋巴结的差异具有统计学意义(P<0.05);CECT 特征中结节最大径、静脉期体积变小边界不清、边缘、边界、结构、VNHU、VNHU-VTHU、VNHU-VMHU、VNHU/VTHU、VNHU/VMHU、ANHU/VNHU、颈部异常淋巴结的差异具有统计学意义(P<0.05).ROC曲线结果显示 5 个诊断模型中模型 4 具有最佳的诊断能力.决策曲线结果表明模型 4 在临床预测中为患者带来最佳的临床净获益.校准曲线结果显示模型 4 具有较好的诊断效果.结论:超声联合CECT的诊断效能均高于单独一种诊断方式,CECT可做为Bethesda Ⅰ、Ⅲ类无明确诊断结节常规超声检查的辅助检查方法,提高良、恶性结节的诊断准确率.
Abstract
Objective:To investigate the diagnostic value of ultrasound(US)combined with contrast-enhanced CT(CECT)in the diagnosis of Bethesda Ⅰ and Ⅲ thyroid nodules with cytologic results via ultrasound-guided fine-needle aspiration(US-FNAB).Methods:One hundred and eighty-four patients with Bethesda Ⅰ and Ⅲ TN who underwent US-FNAB and obtained surgical pathology results at the Affiliated Hospital of Guizhou Medical University between January 2020 and April 2023 were selected,and all of them underwent preoperative US and CECT of the thyroid gland.US and CECT features of patients'thy-roid nodules were collected,and CT values of thyroid nodules,surrounding glands,and neck muscles in the arterial and ve-nous phases were measured.Patients were divided into benign and malignant groups according to the postoperative pathological results of thyroid nodules,and the characteristics of US and CECT of benign and malignant nodules were analyzed by uni-variate analysis,and multifactorial binary logistic regression models were established using the statistically significant parame-ters from US and CECT,with model 1 as the US group,model 2 as the CECT group,model 3 as the C-TIRADS classifica-tion group,model 4 as the model 1+model 2 combined diagnostic group,and model 5 for model 2+model 3 combined diag-nostic group.The diagnostic performance of the models was compared by constructing ROC curves,calibration curves and de-cision curves using postoperative pathologic results of thyroid nodules as the gold standard.Results:The differences in ultra-sound characteristics among benign and malignant groups in nodal maximum diameter,structure,orientation,margin,border,focal strong echoes,posterior echoes,envelope integrity and lymph node were statistically significant(P<0.05).Differences in CECT features of nodule maximum diameter,vein-phase volume becoming small border unclear,margin,border,structure,VNHU,VNHU-VTHU,VNHU-VMHU,VNHUU/VTHU,VNHU/VMHU,ANHU/VNHU,and abnormal lymph nodes in the neck were statistically signifi-cant(P<0.05).The results of the ROC curves showed that model 4 had the best diagnostic ability among the 5 diagnostic models.The decision curve results showed that model 4 provided the best net clinical benefit to patients in clinical predic-tion.The calibration curve results showed that model 4 had better diagnostic performance.Conclusion:The diagnostic efficacy of the combination of the two diagnostic methods is higher than that of the single diagnostic method group,and CECT can be used as an auxiliary examination for routine US in Bethesda Ⅰ and Ⅲ nodules without a definite diagnosis,improving the diagnostic accuracy of benign and malignant nodules.
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