细胞学穿刺未定性甲状腺结节的恶性预测因子探讨

目的：探讨细胞学未定性甲状腺结节的恶性预测因子。方法：回顾性搜集2009年-2013年88例细胞学检查未定性甲状腺结节患者的相关资料。对选定结节进行临床、实验室、MRI、超声和穿刺细胞学（Bethesda分类标准）多方面分析研究，多变量分析后建立预测模型。结果：88例中有25例甲状腺结节为恶性病变（28．41％，25／88）。对比分析良性结节组和恶性结节组，两组中患者的性别、血清FT4水平、有无甲状腺自身免疫性疾病、微钙化的MRI特征、结节中央血流丰富的us特征在两组间差异均无统计学意义（P〉0．05）。微钙化的us特征、边界模糊的MRI特征以及细胞学结果分类第Ⅳ类（Bethesda分类系统）在两组间差异有统计学意义（P〈O．05）。在多变量分析后，预测模型表明Bethesda分类Ⅳ类和微钙化的US特征以及边界模糊的MRI特征均可作为未定性甲状腺结节的恶性预测因子，符合率为88．6％。结论：研究证实Bethesda分类Ⅳ、微钙化的US特征、边界模糊的MRI特征均是未定性甲状腺结节的恶性预测因子。

Study on predictive factors of malignant thyroid nodules with indeterminate cytological results

Objective：To study the predictive factors of malignant thyroid nodules with indeterminate cytological diag- nosis of fine needle aspiration biopsy. Methods：Clinical data of 88 patients with thyroid nodules with indeterminate cytologi- cal examination results in our hospital from 2009 to 2013 were retrospectively collected. The clinical, laboratory, MRI, US and cytological classification （Bethesda criteria） variables of these selected cases were analyzed,and a prediction model was designed after the multivariate analysis. Results：There were 25 cases with malignant thyroid nodules （28.41% ,25/88）. Between benign and malignant nodule groups, there were no significant differences in gender, FT4 blood levels, with autoimmune thyroid disease,rich blood flow in central region by US; there were significant differences in micro-calcifications on US,blurry border on MRI and the Bethesda System category IV. The established multivariate analysis model showed the Bethesda System category IV together with mier~caIcifications on US and blurry border on MRI were predictive factors of malignant thyroid nodules,with 88.6 % diagnostic accuracy. Conclusion：This study confirmed Bethesda System category IV together with micro-calcifications on US and blurry border on MRI were predictive factors of malignancy in indeterminate thyroid nodules.