發(fā)布時(shí)間：2018-06-19 13:04

  本文選題：甲狀腺結(jié)節(jié) + 2015版ATA指南��； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景與目的隨著高頻超聲技術(shù)的快速發(fā)展,甲狀腺結(jié)節(jié)的檢出率也隨之提高,有資料顯示,在隨機(jī)調(diào)查的人群中,被檢出的甲狀腺結(jié)節(jié)約為19%—67%,其中甲狀腺惡性結(jié)節(jié)約占為5%—10%。為規(guī)范甲狀腺結(jié)節(jié)的診斷與治療,2015年,美國(guó)甲狀腺學(xué)會(huì)(American Thyroid Association,ATA)頒布了新版的指南。其因甲狀腺結(jié)節(jié)二維超聲特征的不同將其分為5個(gè)風(fēng)險(xiǎn)系數(shù)不同的組別,如下:1、良性(1%);2、極低度可疑惡性組(3%);3、低度可疑惡性組(5%~10%);4、中度可疑惡性組(10%~20%),5、高度可疑惡性組(70%~90%)。然而ATA指南中,尚有部分結(jié)節(jié)未包含其中,定為“未描述組”。ATA指南推薦低度、中度、高度可疑惡性組行細(xì)針抽吸(fine-needle aspiration,FNA)活檢,然而甲狀腺良惡性結(jié)節(jié)的超聲圖像特征交叉和多變,良惡性結(jié)節(jié)之間存在相似的超聲聲像圖表現(xiàn),并且由于不同的超聲醫(yī)生診斷經(jīng)驗(yàn)的不同,對(duì)相同的結(jié)節(jié)可能給予不同風(fēng)險(xiǎn)類(lèi)別,因此需要另一些檢查手段對(duì)其進(jìn)一步分類(lèi)處理。剪切波彈性(SWE)成像技術(shù)能直觀反映組織的硬度信息,定量評(píng)價(jià)結(jié)節(jié)良惡性。本研究旨在探討SWE成像技術(shù),2015版ATA聯(lián)合SWE成像技術(shù)在甲狀腺結(jié)節(jié)良惡性方面的臨床價(jià)值,探討SWE成像技術(shù)能否提高ATA指南的診斷效能,使一些良性結(jié)節(jié)免于FNA穿刺檢查,從而使ATA在臨床應(yīng)用中,能夠更針對(duì)性的進(jìn)行FNA。資料與方法1.第一部分,收集2015年10月至2016年9月來(lái)我院就診,經(jīng)超聲發(fā)現(xiàn)甲狀腺結(jié)節(jié)175例,均行剪切波彈性成像檢查,測(cè)量每個(gè)結(jié)節(jié)楊氏模量最大值,以術(shù)后病理結(jié)果為金標(biāo)準(zhǔn),得出鑒別甲狀腺良惡性結(jié)節(jié)的最佳界值。2.第二部分,評(píng)價(jià)ATA指南對(duì)甲狀腺結(jié)節(jié)的診斷效能。將極低可疑惡性組的結(jié)節(jié)定為良性,低度可疑惡性組以及以上組別(包括未描述組)的定為惡性,得出ATA指南診斷甲狀腺良惡性結(jié)節(jié)的敏感度,特異度及準(zhǔn)確度;利用第一部分鑒別良惡性結(jié)節(jié)的最佳界值,將低度、中度可疑惡性組及未描述組中大于等于界值的診斷為惡性,低于界值診斷為良性,余不變。得出應(yīng)用SWE技術(shù)后,ATA指南診斷良惡性結(jié)節(jié)的敏感度,特異度及準(zhǔn)確度。比較兩種方法之間敏感度,特異度及準(zhǔn)確度之間的差異。結(jié)果1.本研究的175例結(jié)節(jié)中,良性結(jié)節(jié)82例,惡性結(jié)節(jié)93例,良性結(jié)節(jié)的Emax為39.94±24.45Kpa,惡性結(jié)節(jié)的Emax為79.91±31.79Kpa,惡性結(jié)節(jié)Emax良性結(jié)節(jié)Emax,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。繪制結(jié)節(jié)最大楊氏模量值的ROC曲線(xiàn),得出AUC為0.821,其診斷良惡性結(jié)節(jié)的最佳界值為53.53Kpa,敏感度為90.32%,特異度為80.49%,準(zhǔn)確度為85.71%。2.單獨(dú)應(yīng)用ATA指南,其診斷甲狀腺惡性結(jié)節(jié)的靈敏度為98.92%,特異度為32.93%,準(zhǔn)確度為68.00%;SWE技術(shù)聯(lián)合ATA指南后,其診斷良惡性結(jié)節(jié)的靈敏度為97.85%,特異度為79.36%,準(zhǔn)確度為89.14%。兩種診斷方法靈敏度之間的比較(P0.05),認(rèn)為兩種方法靈敏度之間的差異無(wú)統(tǒng)計(jì)學(xué)意義;特異度、準(zhǔn)確度之間的比較(P0.05),認(rèn)為兩種方法特異度、準(zhǔn)確度之間的差異有統(tǒng)計(jì)學(xué)意義。結(jié)論1.SWE成像技術(shù)能夠定量評(píng)價(jià)結(jié)節(jié)的硬度信息,Emax診斷良惡性結(jié)節(jié)的最佳界53.53Kpa。2.鑒別甲狀腺結(jié)節(jié)良惡性方面,SWE技術(shù)聯(lián)合2015版ATA指南較單獨(dú)應(yīng)用ATA指南能夠在不降低靈敏度同時(shí),提高其特異度和準(zhǔn)確度,從而能夠更有針對(duì)性對(duì)結(jié)節(jié)行FNA穿刺。
[Abstract]:Background and objective with the rapid development of high frequency ultrasound technology, the detection rate of thyroid nodules is also increased. Some data show that the thyroid nodules are about 19% - 67% in the random survey population, and the thyroid malignant nodules are about 5% - 10%. for the diagnosis and treatment of thyroid nodular nodules, 2015, American thyroid American Thyroid Association (ATA) issued a new version of the guide. It was divided into 5 different groups of risk factors for thyroid nodule two-dimensional ultrasound characteristics, as follows: 1, benign (1%); 2, extremely low suspected malignant group (3%); 3, low-grade suspected malignant group (5%~10%); 4, moderately suspicious malignant group (10%~20%), 5, highly suspected malignant group (70%~9). 0%). However, in the ATA guide, there are still some nodules not included, and the "undescribed group".ATA guide recommends a low, moderate, and highly suspected malignant group with fine needle aspiration (fine-needle aspiration, FNA) biopsy. However, the ultrasonographic features of benign and malignant thyroid nodules are intersected and varied, and there is a similar ultrasonic image between benign and malignant nodules. The graphical representation, and the different diagnostic experiences of different doctors, may give different types of risk to the same nodules, and therefore need to be further classified by other means. The shear wave elasticity (SWE) imaging technique can directly reflect the organizational hardness information and quantify the nodules and malignancies. The aim of this study is to explore the SWE formation. Like technology, the clinical value of the 2015 version of ATA combined with SWE imaging technique in the benign and malignant thyroid nodules, explore whether SWE imaging technology can improve the diagnostic efficiency of the ATA guide, and make some benign nodules free from FNA puncture examination, so that in clinical application, ATA can be more targeted to the first part of the FNA. data and method 1., and collect the 2015 10. From month to September 2016 to our hospital, 175 cases of thyroid nodules were detected by ultrasound, all of them were examined by shear wave elastic imaging and measured the maximum Young's modulus of each nodule. The best boundary value.2. second for differentiating benign and malignant thyroid nodules was obtained by the postoperative pathological results as gold standard, and the diagnostic efficacy of the ATA guide for thyroid nodules was evaluated. The nodules of the extremely low and suspected malignant groups were benign, the lower suspected malignant group and the above group (including the undescribed group) were malignant, and the sensitivity, specificity and accuracy of the ATA guide for the diagnosis of thyroid benign and malignant nodules; the best boundary value of the first part to identify the benign and malignant nodules, the low, moderate, suspicious and malignant groups and undescribed groups were used. The diagnosis of the value greater than the boundary value was malignant, and the value below the boundary value was benign. The sensitivity, specificity and accuracy of the ATA guide for the diagnosis of benign and malignant nodules were obtained. The differences between the sensitivity, specificity and accuracy of the two methods were compared between the two methods. Results in the 1. studies, 175 cases of nodules, 82 cases of benign nodules, and malignant. There were 93 cases of nodules, Emax of benign nodules were 39.94 + 24.45Kpa, Emax of malignant nodules were 79.91 + 31.79Kpa, and malignant nodules were Emax benign nodules Emax. The difference was statistically significant (P0.05). The ROC curve of the maximum Young's modulus value was drawn, and AUC was 0.821. The best boundary value for the diagnosis of benign and malignant nodules was 53.53Kpa, the sensitivity was 90.32%, the specificity was the degree of specificity. 80.49%, the accuracy was 85.71%.2. alone with the ATA guide, the sensitivity of the diagnosis of thyroid malignant nodules was 98.92%, the specificity was 32.93%, and the accuracy was 68%; the sensitivity of the diagnosis of benign and malignant nodules was 97.85%, the specificity was 79.36%, and the accuracy of the 89.14%. two diagnostic methods was compared (P0.0). 5), the differences between the sensitivity of the two methods were not statistically significant; the specificity and accuracy were compared (P0.05), and the difference between the two methods and the accuracy was statistically significant. Conclusion 1.SWE imaging technique can quantitatively evaluate the hardness information of the nodules, and the best boundary of Emax for the diagnosis of benign and malignant nodules is 53.53Kpa.2. identification. In terms of benign and malignant adenoid nodules, the SWE technique combined with the 2015 edition of the ATA guide is more sensitive than the ATA guide, and improves its specificity and accuracy, so as to be more targeted to the nodules for FNA puncture.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R445.1;R581

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 馬兆生;張盼盼;吳X椆，

本文編號(hào)：2039983