多模态超声与超声引导下细针穿刺抽吸活检鉴别C-TIRADS 4类甲状腺良、恶性结节

目的 比较多模态超声与超声引导下细针穿刺抽吸（US-FNAB）活检鉴别中国甲状腺影像报告和数据系统（C-TIRADS）4类甲状腺良、恶性结节的价值。方法 回顾性分析201例甲状腺结节患者共247个甲状腺结节，包括193个恶性、54个良性，以术后病理为金标准，对比多模态超声联合应用常规超声、剪切波弹性成像（SWE）及超声造影（CEUS）]与US-FNAB鉴别甲状腺良、恶性结节的价值。结果 常规超声诊断甲状腺恶性结节的敏感度、特异度、准确率、误诊率及漏诊率分别为86.53%、59.26%、80.57%、40.74%及13.47%；SWE分别为78.76%、74.07%、77.73%、25.93%及21.24%；CEUS分别为90.16%、77.78%、87.45%、22.22%及9.84%；多模态超声分别为97.93%、88.89%、95.95%、11.11%及2.07%；US-FNAB分别为89.64%、96.30%、91.09%、3.70%及10.36%。多模态超声鉴别甲状腺良、恶性结节的敏感度、特异度、准确率高于，而漏诊率和误诊率低于单一常规超声、SWE及CEUS（P均<0.05）；其敏感度、准确率和误诊率高于，而特异度和漏诊率低于US-FNAB（P均<0.05）。结论 对于鉴别C-TIRADS 4类甲状腺良、恶性结节，多模态超声敏感度、准确率较高但误诊率高，US-FNAB特异度较高但漏诊率高。

Multimodal ultrasound and ultrasound-guided fine-needle aspiration biopsy for distinguishing benign and malignant thyroid nodules of C-TIRADS grade 4

Objective To compare the value of multimodal ultrasound and ultrasound-guided fine-needle aspiration biopsy (US-FNAB) for distinguishing benign and malignant thyroid nodules of Chinese thyroid imaging reporting and data system (C-TIRADS) grade 4. Methods Data of 247 thyroid nodules in 201 patients were retrospectively analyzed, including 193 malignant and 54 benign noes. Taken postoperative pathology as the gold standards, the value of multimodal ultrasound, i.e. the combination of conventional ultrasound, shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS) and US-FNAB for distinguishing benign and malignant thyroid nodules were compared. Results The sensitivity, specificity, accuracy, misdiagnosis rate and rate of missed diagnosis of conventional ultrasound for diagnosing malignant thyroid nodules was 86.53%, 59.26%, 80.57%, 40.74% and 13.47%, respectively, of SWE was 78.76%, 74.07%, 77.73%, 25.93% and 21.24%, respectively, of CEUS was 90.16%, 77.78%, 87.45%, 22.22% and 9.84%, respectively, while of multimodal ultrasound was 97.93%, 88.89%, 95.95%, 11.11% and 2.07%, respectively, and of US-FNAB was 89.64%, 96.30%, 91.09%, 3.70% and 10.36%, respectively. The sensitivity, specificity and accuracy of multimodal ultrasound for distinguishing benign and malignant thyroid nodules were higher, while the misdiagnosis rate and missed diagnosis rate were lower than those of conventional ultrasound, SWE and CEUS alone. The sensitivity, accuracy and misdiagnosis rate of multimodal ultrasound were higher, while its specificity and missed diagnosis rate were both lower than those of US-FNAB (all P<0.05). Conclusion For distinguishing benign and malignant thyroid nodules of C-TIRADS grade 4, multimodal ultrasound had higher sensitivity and accuracy but higher misdiagnosis rate, while US-FNAB had higher specificity but also higher missed diagnosis rate.