弹性成像对甲状腺微小癌的诊断价值

目的：探讨高频超声结合弹性成像对甲状腺微小癌的诊断价值。方法：收集2015年1月至2018年1月温州市中心医院经细针穿刺活检或手术治疗的甲状腺微小癌患者68例，回顾性分析高频超声特征、弹性成像评分及应变率比值并进行定性诊断，将其与手术或细针穿刺结果进行对比。结果：68例患者共87个结节，高频超声结合弹性成像诊断良性微小结节55个，甲状腺微小癌32个；手术或细针穿刺结果诊断良性微小结节59个，甲状腺微小癌28个。高频超声结合弹性成像评分诊断甲状腺微小癌的敏感度、特异度、准确度、阳性预测值及阴性预测值分别为89.2%、89.8%、89.7%、80.6%和89.8%；ROC曲线结果显示，弹性应变率比值的最佳截断值为2.98，其诊断甲状腺微小癌的敏感度、特异度、准确度、阳性预测值及阴性预测值分别为82.1%、84.7%、83.9%、71.8%和90.1%。结论：高频超声是微小甲状腺癌评估的基础，结合弹性成像可以提高对微小甲状腺癌的诊断价值。

The clinical value of elastography in the diagnosis of thyroid microcarcinoma

Objective: To explore the value of high frequency ultrasonography combined with elastography in the diagnosis of thyroid microcarcinoma. Methods: Totally 68 thyroid microcarcinoma patients were collected after fine needle biopsy or surgical treatment. High-frequency ultrasonic features, elastography score and strain rate ratio were retrospectively analyzed and qualitative diagnosis was made. The results were compared with those of surgery or fine needle puncture. Results: There were 87 nodules in 68 thyroid microcarcinoma patients of which 55 benign nodules and 32 thyroid cancers diagnosed by high-frequency ultrasound combined with elastography. Surgical or fine-needle aspiration results showed 59 benign nodules and 28 thyroid carcinomas. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of high-frequency ultrasound combined with elastography score in the diagnosis of minimal thyroid cancer were 89.2%, 89.8%, 89.7%, 80.6% and 89.9%, respectively, in contrast to 82.1%, 84.7%, 83.9%, 71.8% and 90.1% of thyroid microcarcinoma. Conclusion: High-frequency ultrasound is an important basis for thyroid nodule evaluation. The application of elastography can significantly improve the diagnostic value of ultrasound in the benign and malignant evaluation of thyroid small nodule.