实时超声弹性成像技术结合血清促甲状腺激素在甲状腺微小乳头状癌诊断中的价值*

目的：探讨实时超声弹性成像技术联合促甲状腺激素（ TSH）在老年甲状腺微小乳头状癌（ PTMC）诊 断中的价值。方法：选取本院接受手术治疗的甲状腺微小结节患者及健康体检者。术前所有患者均进行实时超 声弹性成像技术检查，以病理诊断为“金标准”，分析实时超声弹性成像技术诊断甲状腺微小乳头状癌的准确 率、特异度及灵敏度。比较良恶性结节的弹性成像评分，采用化学发光法检测所有受试者血清TSH水平。结果： 经术后病理检查有60.00% 患者确诊为良性结节（ 共85 个良性结节，占58.62%），有40.00% 患者确诊为恶性结 节（ 共60 个恶性结节，占41.38%）。实时超声弹性成像技术诊断甲状腺微小乳头状癌的灵敏度为92.50%，特异度 为83.08%，准确性为88.28%。实时超声弹性成像诊断与病理诊断有较高的一致性。 恶性组1 ～ 2 分的比例显著 低于良性组，3 ～ 4 分的比例显著高于良性组，差异具有统计学意义。良性组和恶性组血清TSH水平均显著高于 对照组，恶性组血清TSH水平显著高于良性组，差异具有统计学意义。受试者工作特征（ ROC）曲线结果显示， 超声弹性成像联合TSH检测其ROC曲线下面积为0.869，95%CL（0.789 ～ 0.949），联合诊断最佳截点为TSH= 2.16（ mIU/L），此时诊断敏感度为0.646，诊断特异度为0.575。超声弹性成像诊断老年甲状腺微小乳头状癌ROC 曲线下面积为0.814，95%CL（0.721 ～ 0.907），联合诊断曲线下面积高于超声弹性成像。结论：实时超声弹性成 像联合血清TSH检测对甲状腺微小状乳头癌具有较高诊断价值，且联合检测诊断价值高于实时超声弹性成像。

The value of real-time ultrasound elastic imaging combined with serum thyroid stimulating hormone in the diagnosis of thyroid micropapilla carcinoma*

Objective To study the value of real-time ultrasound elastic imaging combined with serum thyroid stimulating hormone（ TSH） in the diagnosis of thyroid micropapilla carcinoma. Methods Sixty patients nodules with 145 thyroid micronodules who underwent surgical treatment in our hospital were selected. At the same time， 32 cases of healthy physical examination were selected. Real-time ultrasonic elastic imaging was performed in all patients before operation. The accuracy， specificity and sensitivity of real-time ultrasound elastic imaging in the diagnosis of thyroid micropapillary carcinoma were analyzed by using pathological diagnosis as“ gold standard”. The elastic imaging scores of benign and malignant nodules were compared， and the level of serum TSH were measured by chemiluminescence method. Results After postoperative pathological examination，60.00% of patients were diagnosed as benign nodules（ 85 benign nodules， 58.62%）， and 40.00% were diagnosed as malignant nodules（ 60 malignant nodules， 41.38%）. The sensitivity， specificity and accuracy of real-time ultrasound elastic imaging in the diagnosis of thyroid micropapilla carcinoma were 92.50%， 83.08% and 88.28% respectively. The diagnosis of realtime ultrasonic elastic imaging was in good agreement with pathological diagnosis. The proportion of 1-2 in malignant group was significantly lower than that of benign group， and the proportion of 3-4 was significantly higher than that of benign group. The level of serum TSH in malignant group was significantly higher than that in benign group. The ROC curve results showed that the area under ROC detected by ultrasonic elastic imaging combined with TSH was 0.869， 95% CL（ 0.7890-949）. The best cut point for combined diagnosis was TSH=2.16（ mIU/L）. The diagnosticsensitivity and specificity were 0.646 and 0.575 respectively. The area under ROC curve in the diagnosis of thyroid micropapilla carcinoma was 0.814， 95% CL （0.721-0.907）， and the area under the combined — 131 — diagnostic curve was higher than that in ultrasonic elastic imaging. Conclusion The real-time ultrasonic elastography combined with the serum TSH detection has high diagnostic value for the thyroid-like nipple carcinoma， and the combined detection and diagnosis value is higher than that of t he real-time ultrasonic elastography.