【摘要】 目的：为适应国家即将开展的分级医疗，为基层医院探索一种方便、准确、快速、经济地鉴别甲状腺结节性质的诊断手段，比较超声检查（CUS）与超声引导下甲状腺细针穿刺细胞学检查（US-FNAC）诊断结果，评价超声检查在甲状腺结节良恶性鉴别诊断中的价值。方法：2018—2020年，经US-FNAC确诊的204例甲状腺结节患者，分析甲状腺结节的超声特性，包括钙化情况、结节边缘、血管分布、回声特性，超声检测结果和US-FNAC结果比较，计算诊断符合率、敏感度、特异度、误诊率、漏诊率；利用ROC曲线评估超声检查对甲状腺结节的诊断效能。结果：204例中，US-FNAC诊断良性结节177例，其中171例超声诊断良性，超声诊断良性结节诊断符合率94.3%，敏感度96.1%，特异度为81.8%，漏诊率3.8%，误诊率18.1%;27例US-FNAC确诊为恶性结节中33例超声诊断恶性结节，超声诊断良性结节诊断符合率97.1%，敏感度100.0%，特异度96.7%，漏诊率为0，误诊率3.2%，超声诊断和US-FNAC结果有高度的一致性（P=0.001）。超声检查的各项指标中，甲状腺结节钙化（P=0.001）、结节边缘（P=0.031）、结节回声纹理（P=0.001）和血管分布（P=0.048）相关关系密切。ROC曲线分析显示，超声检查对甲状腺结节良恶性的鉴别有良好的诊断效能，甲状腺结节性质ROC曲线面积依次为结节钙化、结节边缘、回声纹理、血管分布。结论：超声和US-FNAC诊断甲状腺结节良恶性结果一致性良好，超声鉴别甲状腺结节良恶性准确度较高，能够为结节定性诊断及治疗方案的制定提供有价值的影像学依据和参考。更多还原

【Abstract】 Objective: In order to adapt to our country to carry out the classification of medical treatment, for basic-level hospitals to explore a convenient, rapid, accurate and economic means to identify the diagnosis of thyroid nodule properties, comparing ultrasound(US) and thyroid ultrasound guided fine needle aspiration cytology(US-FNAC) diagnosis and evaluation of ultrasound in the diagnosis of benign and malignant thyroid nodule differential value. Methods: From 2018 to 2020, 204patients with thyroid nodules diagnosed by US-FNAC were analyzed for the ultrasonic characteristics of thyroid nodules, including calcification, nodule edge, vascular distribution, and echo characteristics.The ultrasonic detection results were compared with US-FNAC results, and the diagnostic coincidence rate, sensitivity, specificity, misdiagnosis rate and missed diagnosis rate were calculated. ROC curve analysis was used to evaluate the diagnostic efficacy of ultrasound in thyroid nodules. Results: Among the 204 cases, 177 cases were diagnosed as benign nodules by US-FNAC, while 171cases were diagnosed as benign by ultrasound. The diagnostic coincidence rate of benign nodules was 94.3%, the sensitivity was 96.1%, the specificity was 81.8%, the missed diagnosis rate was3.8%, and the misdiagnosis rate was 18.1%. Twenty-seven cases were diagnosed as malignant nodules by US-FMAC, while 33 cases were diagnosed as malignant nodules by ultrasound. The diagnostic coincidence rate of benign nodules was 97.1%, the sensitivity was 100.0%, the specificity was 96.7%, the missed diagnosis rate was 0%, and the misdiagnosis rate was 3.2%. The results of ultrasonic diagnosis and us-fnac were highly consistent(P=0.001). Among the indicators of ultrasonic examination, thyroid nodule calcification(P=0.001), nodule edge(P=0.031), nodule echo texture(P=0.001) and vascular distribution(P=0.048) were closely correlated. ROC curve analysis showed that ultrasonic examination had a good diagnostic efficiency in the differentiation of benign and malignant thyroid nodules. The ROC curve area of thyroid nodules was in the order of nodular calcification,nodular edge, echo texture and vascular distribution. Conclusion: Ultrasound and US-FNAC were consistent in the diagnosis of benign and malignant thyroid nodules. Ultrasound is effective in differentiating benign and malignant thyroid nodules, which can provide valuable imaging basis and reference for the qualitative diagnosis and treatment of thyroid nodules.更多还原