【作者】 吴琼；

【导师】 王燕；

【作者基本信息】 上海交通大学 ， 影像医学与核医学， 2015， 硕士

【摘要】 第一部分细针穿刺和弹性成像联合应用对甲状腺结节的诊断价值目的初步探讨超声引导下细针穿刺活检和实时弹性成像联合应用对疑难甲状腺结节良恶性诊断的临床价值。方法回顾性分析在本院同时接受常规超声、实时超声弹性成像以及超声引导下细针穿刺活检的84例甲状腺结节患者的105个疑难结节,分别评估实时弹性成像与细针穿刺活检结果,并与相应手术病理、临床随访结果进行对照分析。结果在纳入研究的105个甲状腺结节中,经手术病理或临床随访证实,良性结节68个(68/105,64.76%),恶性结节37个(37/105,35.24%)。常规超声联合实时超声弹性成像诊断甲状腺结节良恶性的敏感度为72.97%(27/37),特异度为30.88%(21/68),准确率为45.71%(48/105)。进一步超声引导下细针穿刺活检结果诊断的敏感度为75.68%(28/37),特异度为88.24%(60/68),准确率为83.81%(88/105)。比较进一步细针穿刺活检结果与常规超声联合弹性成像的诊断效能,两者的诊断敏感度无显著差异(P>0.05),但是细针穿刺诊断结节良恶性的特异度、准确率均高于弹性成像,差异有统计学意义(P<0.05)。结论无论是常规超声联合实时超声弹性成像,还是超声引导下细针穿刺活检,在诊断甲状腺结节良恶性的过程中均存在一定的局限性。本研究表明对于前者检查后仍然定性困难的结节选择进一步细针穿刺,可明显提高诊断甲状腺结节的特异度和准确率。第二部分细针穿刺和弹性成像在诊断甲状腺结节中的相关影响因素分析目的分析超声引导下细针穿刺活检和实时超声弹性成像在诊断疑难甲状腺结节良恶性过程中的相关影响因素。方法回顾性分析在本院同时接受常规超声、实时超声弹性成像以及超声引导下细针穿刺活检的116例共142个疑难甲状腺结节。比较超声引导下细针穿刺活检、实时超声弹性成像两者诊断不同大小(≤5mm、5~10mm、10~20mm、>20mm),是/否合并桥本氏甲状腺炎组甲状腺结节良恶性的敏感度、特异度和准确率差异。结果在纳入研究的142个甲状腺结节中,经手术病理或临床随访证实,良性结节81个,恶性结节61个。用弹性评分3~5分诊断甲状腺癌的敏感度为83.61%(51/61),特异度为34.57%(28/81),准确率为55.63%(79/142);用细胞学阳性(恶性、可疑恶性病变)诊断甲状腺的敏感度为86.89%(53/61),特异度为97.53%(79/81),准确率为92.96%(132/142)。对于≤5mm、5~10mm、10~20mm、>20mm四个不同大小结节组,实时超声弹性成像的诊断准确率分别为56.25%、48.05%、65.79%、72.73%,组间无统计学差异(P>0.05);细针穿刺细胞学的诊断准确率分别为93.75%、94.81%、89.47%、90.91%,组间也无统计学差异(P>0.05)。对于是否合并桥本氏甲状腺炎结节两组,实时超声弹性成像的诊断准确率分别为43.14%、53.85%,组间无统计学差异(P>0.05);细针穿刺细胞学的诊断准确率分别为88.24%、94.51%,组间也无统计学差异(P>0.05)。结论超声引导下细针穿刺活检、实时超声弹性成像诊断疑难甲状腺结节良恶性的准确率均不受大小、桥本氏甲状腺炎的影响,两者均可为常规超声中存在诊断困难的甲状腺结节的良、恶性诊断提供更多有价值的信息。更多还原

【Abstract】 Section I The value of fine-needle aspiration biopsy combined with elastography in the diagnosis of thyroid nodulesObjective To evaluate the diagnostic value of ultrasound-guided fine-needle aspiration(US-FNAB)combined with real-time ultrasound elastography(RTE) in the diagnosis of suspicious thyroid nodules.Methods A retrospective analysis of 84 patients with 105 suspicious thyroid nodules in our hospital was undertaken, including corresponding examination of conventional ultrasound, RTE and US-FNAB. RTE scores and FNA cytopathology results were evaluated respectively, and then were compared with surgical biopsy and clinical follow-up for analysis.Results In the 105 included thyroid nodules, 68 were benign(68/105, 64.76%) and 37 were malignant(37/105,35.24%) confirmed by surgical biopsy and clinical follow-up. The combined diagnosis of conventional US and RTE had a sensitivity of 72.97%(27/37), a specificity of 30.88%(21/68)and an accuracy of 45.71%(48/105) in the diagnosis of thyroid nodules. While the corresponding sensitivity, specificity and accuracy of further FNA cytopathology were 75.68%(28/37), 88.24%(60/68) and 83.81%(88/105), respectively. Though there was no statistically significant difference in the diagnostic sensitivity(P>0.05), the difference of specificity and accuracy between further US-FNAB and the combined diagnosis of conventional US and RTE was found significant( P<0.05).Conclusion For all the diagnoses of thyroid nodules, there is certain limitation in both the combined application of conventional US with RTE and further US-FNAB. However, as to some suspicious thyroid noudules which is difficult to diagnose with the combined application of conventional US with RTE, fine needle aspiration cytopathology could help provide higher specificity and accuracy for predicting thyroid malignancy.SectionⅡThe analysis of influencing factors in the diagnosis of thyroid nodules with fine-needle aspiration and elastographyObjective To analyze the influencing factors of ultrasound-guided fine-needle aspiration biopsy(US-FNAB)and real-time ultrasound elastography(RTE)in diagnosis of thyroid nodules.Methods A retrospective analysis of 116 patients with 142 thyroid nodules was undertaken, including corresponding examination of conventional ultrasound,RTE and US-FNAB. Comparison of the two methods in the accuracy rate of diagnosis was made in thyroid nodules of different size, with or without the coexistence of Hashimoto’s thyroiditis(HT).Results In 142 included thyroid nodules, 81 were benign and 61 were malignant confirmed by surgical biopsy and clinical follow-up. The diagnosis of conventional ultrasound and RTE had a sensitivity of 83.61%(51/61), a specificity of 30.88%(21/68) and an accuracy of 55.63%(79/142). While the corresponding sensitivity, specificity and accuracy of US-FNAB were86.89%(53/61), 97.53%(79/81), 92.96%(132/142), respectively. Among different size groups(≤5mm, 5 ~ 10 mm, 10 ~ 20 mm, >20mm), diagnostic accuracy of RTE was 56.25%,48.05%, 65.79%, 72.73%, while diagnostic accuracy of US-FNAB was 93.75%, 94.81%,89.47%, 90.91%, respectively. There was no statistically significant difference in the diagnostic accuracy of both RTE and US-FNAB between different size(P > 0.05). Among groups with or without the coexistence of Hashimoto’s thyroiditis, diagnostic accuracy of RTE was 43.14%, 53.85%. While diagnostic accuracy of US-FNAB was 88.24%, 94.51%,respectively. There was also no statistically significant difference in the diagnostic accuracy of both RTE and US-FNAB between HT and non-HT group(P>0.05).Conclusion In the diagnosis of thyroid nodules, size and coexistence of Hashimoto’s thyroiditis seemed not to be the the influencing factors of US-FNAB and RTE. However, both of the two new techniques could provide more valuable information in addition to conventional sonographic features for the diagnosis of suspicious thyroid nodules.更多还原