常规超声特征联合内部粗大钙化特征鉴别甲状腺结节良恶性的价值

目的探讨常规甲状腺结节声像图特征联合内部粗大钙化特征鉴别结节良恶性的价值。 方法回顾性分析2018年1月至2020年7月于常州市第一人民医院就诊并经病理证实的217例患者共229个甲状腺结节的超声图像。纳入结节的超声声像图均提示结节内存在粗大钙化。以病理结果为金标准，将甲状腺结节分为良性组（n=110）和恶性组（n=119）。单因素分析比较2组结节的常规超声声像图特征以及内部粗大钙化特征的差异，其中常规结节特征包括最大径、纵横比、回声强度、生长方式、成分、边缘和彩色多普勒血流信息，内部粗大钙化特征包括厚度、钙化连续性中断（简称“中断”）、形态、钙化外软组织边缘、钙化回声均匀性和位置。采用二元Logistic回归分析建立常规结节特征、常规结节特征与内部粗大钙化特征相结合的联合预测模型（模型1、模型2）。采用ROC曲线和Z检验分析比较各参数及联合预测模型的诊断效能。 结果恶性组甲状腺结节的最大径≤1.25 cm、纵横比＞0.78、实性成分、垂直位生长、边缘不规则或腺外侵犯以及内部粗大钙化厚度不规则、中断、回声高低不一、存在软组织边缘、中央型钙化均较良性组多见，且差异均具有统计学意义（P均＜0.05）。模型1纳入结节最大径、纵横比和边缘，模型2纳入结节最大径、纵横比、钙化厚度、连续性中断和钙化位置。模型2的敏感度、特异度、阳性预测值、阴性预测值和准确性分别为81.85%、82.73%、82.29%、80.18%和81.22%，其ROC曲线下面积高于模型1（0.877 vs 0.753，Z=4.197，P＜0.001）。 结论结节内粗大钙化厚度不规则、连续性中断、中央型钙化等声像图特征有助于结节良恶性的诊断。在观察结节常规声像图特征的同时，联合评估内部粗大钙化的特征对鉴别甲状腺结节的良恶性有重要意义。

Value of conventional ultrasound characteristics combined with internal coarse calcification characteristics in differentiating benign and malignant thyroid nodules

ObjectiveTo assess the value of conventional sonographic characteristics of thyroid nodules combined with internal coarse calcification in differentiating benign and malignant thyroid nodules. MethodsThe ultrasonographic data of 217 patients with 229 thyroid nodules confirmed by pathology at Changzhou First People's Hospital from January 2018 to July 2020 were retrospectively analyzed. Ultrasonography of the included nodules showed that there were coarse calcifications in the nodules. According to the gold standard of pathological results, the nodules were divided into either a benign (n=110) or a malignant (n=119) group. The conventional sonographic characteristics of nodules including maximum diameter, anteroposterior/transverse diameter ratio, echo intensity, growth pattern, composition, margin, and color Doppler flow imaging, and sonographic characteristics of coarse calcification including thickness, calcification interruption, morphology, margin of soft tissue outside the calcification, echo consistency, and location were analyzed retrospectively. Univariate analysis was used to compare the conventional sonographic characteristics of nodules and coarse calcification in nodules between the two groups. Binary logistic regression was used to establish prediction models of conventional nodule characteristics (model 1) and the comprehensive characteristics of nodules and coarse calcification (model 2). The diagnostic performance of each parameter and the combined model was compared by receiver operating characteristic curve (ROC) analysis and Z-test. ResultsThe maximum diameter of thyroid nodules ≤1.25 cm, anteroposterior/transverse diameter ratio >0.78, being solid, vertical growth, irregular margin or extra-thyroidal extension, as well as irregular thickness, interruption, echo inconsistency, soft tissue edge ,and central type of coarse calcification were significantly more common in the malignant group than in the benign group (P＜0.05). Model 1 included the maximum diameter, anteroposterior/transverse diameter ratio, and margin of the nodule. In model 2, the maximum diameter of nodule, anteroposterior/transverse diameter ratio, and calcification thickness, interruption, and location were included. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of model 2 were 81.85%, 82.73%, 82.29%, 80.18%, and 81.22%, respectively. The area under the curve was 0.877, which was significantly higher than that of model 1 (0.753; Z=4.197, P＜0.001). ConclusionSonographic characteristics such as irregular thickness, interruption, and central calcification in nodules are helpful for the diagnosis of malignant nodules. While observing the sonographic characteristics of thyroid nodules, it is important to evaluate the characteristics of internal coarse calcification in order to better distinguish benign and malignant thyroid nodules.