超声造影联合细针穿刺手感对甲状腺乳头状癌的诊断价值

 目的 探讨超声造影(contrast enhanced ultrasound, CEUS)和超声引导下细针穿刺细胞学检查(fine-needle aspiration cytology, FNAC,简称“穿刺手感”)及二者联合诊断甲状腺乳头状癌(papillary thyroid carcinoma ,PTC)的价值。方法 回顾性分析2017-09至2020-01解放军总医院海南医院超声诊断科进行超声检查、CEUS及超声引导下穿刺手感患者312例(312个结节),每个结节在穿刺过程中均记录穿刺手感,最终以手术病理结果为金标准。采用特征曲线(ROC)评价CEUS、穿刺手感和两者联合应用的诊断效果。结果 312例中共有良性结节116个,196个诊断为PTC。穿刺手感联合CEUS的准确率(97.450%)高于单独使用CEUS(87.244%)或穿刺手感(63.776%),差异有统计学意义(P<0.05)。CEUS和穿刺手感联合诊断甲状腺结节ROC曲线下面积(0.767)大于单独使用超声造影(0.734)及穿刺手感(0.711),差异均有统计学意义(P<0.05),但CEUS与穿刺手感在诊断PTC ROC曲线下面积差异无统计学意义。结论 CEUS联合穿刺手感对PTC诊断的准确性高于单一使用超声造影或穿刺手感。

Diagnostic value of contrast-enhanced ultrasound combined with puncture feeling of fine-needle aspiration cytology for papillary thyroid carcinoma

Objective To assess the value of contrast-enhanced ultrasound (CEUS), puncture feeling of fine-needle aspiration cytology (FNAC) and their combination in the diagnosis of papillary thyroid carcinoma (PTC).Methods Between September 2017 and January 2020, a total 312 patients with 312 nodules were examined with conventional ultrasound, CEUS and FNAC techniques. The puncture feeling of each thyroid nodule during FNAC was scored. Pathological results after surgery served as the gold standard. The receiver operating characteristic (ROC) curves were used to evaluate the diagnostic accuracy of CEUS, FNAC and their combination respectively.Results Pathological results showed that 116 nodules were benign and 196 nodules were PTC. The accuracy rate of puncture feeling during FNAC combined with CEUS (97.450%) was higher than that of CEUS (87.244%) or puncture feeling used alone (63.776%) (P<0.05). The area under the ROC curve of the combination of CEUS and puncture feeling (0.767) was significantly larger than that of CEUS (0.734) (P<0.05), or that of puncture feeling during FNAC (0.711) (P<0.05), respectively. However, there was no significant difference in the area under the ROC curve between CEUS and puncture feeling during FNAC in the diagnosis of PTC.Conclusions The combination of CEUS and puncture feeling during FNAC is more accurate in the diagnosis of PTC than either used alone.