甲狀腺良惡性結(jié)節(jié)的多模態(tài)超聲研究
發(fā)布時間：2018-07-28 16:23
【摘要】：第一部分不同大小的甲狀腺結(jié)節(jié)超聲造影定性和定量分析目的:探討不同大小的甲狀腺結(jié)節(jié)的超聲造影定性和定量分析價值。方法:178例患者共178個甲狀腺結(jié)節(jié)術(shù)前行超聲造影,所有結(jié)節(jié)均經(jīng)手術(shù)病理證實(良性74個,惡性104個)。按結(jié)節(jié)最大徑線分2組(≤1cm或1 cm),(1)定性評估結(jié)節(jié)造影的強(qiáng)化過程、程度、均勻性、有無環(huán)形增強(qiáng)、強(qiáng)化后的邊界、形狀和大小的超聲造影特征。Fisher確切概率法比較良惡性結(jié)節(jié)造影特征的差異。ROC評價甲狀腺超聲造影的診斷價值。(2)定量分析繪制結(jié)節(jié)感興趣區(qū)(ROI)和實質(zhì)ROI的時間-強(qiáng)度曲線(TIC),記錄各造影參數(shù)峰值強(qiáng)度(Peak)、達(dá)峰時間(TtoPk)及曲線下面積(Area)等,并計算結(jié)節(jié)ROI減去實質(zhì)ROI的各超聲造影參數(shù)△Peak、△Area等。t檢驗比較甲狀腺良惡性結(jié)節(jié)造影參數(shù)的差異。結(jié)果:(1)CEUS示1cm和≤1cm組的甲狀腺良惡性結(jié)節(jié)強(qiáng)化程度、過程、均勻性、強(qiáng)化后的形狀差異均有統(tǒng)計學(xué)意義(P0.05),強(qiáng)化后的大小均無統(tǒng)計學(xué)意義(P0.001)。僅1cm甲狀腺結(jié)節(jié)強(qiáng)化后的邊界、強(qiáng)化完全、環(huán)形增強(qiáng)差異均有統(tǒng)計學(xué)意義(P0.05)。ROC示CEUS診斷1 cm和≤1 cm甲狀腺良惡性結(jié)節(jié)最佳閾值均為3.5,曲線下面積分別為0.869(95%可信區(qū)間0.806～0.932)和0.864(95%可信區(qū)間0.717～1.000),1cm組CEUS的敏感性和特異性分別為75.8%、91.9%;≤1cm組CEUS的敏感性和特異性分別為89.5%、83.3%。(2)》1cm良性結(jié)節(jié)Peak、△Area、△Peak和△Grad大于惡性結(jié)節(jié)(P=0.001,P=0.012,P=0.001,P=0.004)�！�1cm 良性結(jié)節(jié)的 Area、Peak、△Area 和△Grad 大于惡性結(jié)節(jié)(P=0.001,P=0.003,P=0.003,P=0.008)。結(jié)論:對于不同大小的甲狀腺結(jié)節(jié),超聲造影有助于其鑒別診斷。第二部分甲狀腺癌的超聲多模態(tài)診斷研究背景:高分辨率超聲(Ultrasonography,US)是診斷甲狀腺結(jié)節(jié)最敏感的方法,但良惡性鑒別較困難。超聲新技術(shù)彈性超聲(US elastography,USE)、超聲造影(contrast-enhanced US,CEUS)目前也應(yīng)用于臨床。細(xì)針穿刺細(xì)胞學(xué)檢查(fine needle aspiration cytology,FNAC)是術(shù)前診斷甲狀腺良惡性結(jié)節(jié)價值最高的手段,但仍有20%～25%結(jié)節(jié)無法診斷。目的:探究US、USE、CEUS聯(lián)合診斷,FNAC聯(lián)合BRAF(V600E)基因突變診斷甲狀腺癌的應(yīng)用價值。方法:275例患者共320枚甲狀腺結(jié)節(jié)同時行US、USE、CEUS和FNAC,經(jīng)手術(shù)病理證實良性114例,惡性206例。其中有33例患者38枚甲狀腺結(jié)節(jié)(良性4例,惡性34例)同時行穿刺標(biāo)本BRAF基因檢測。繪制US、USE、CEUS和聯(lián)合評分ROC,計算并比較曲線下面積(the area under the ROC,AUC),選取合適截斷點計算聯(lián)合評分的診斷效能。并分析FNAC聯(lián)合BRAF(V600E)基因突變對甲狀腺癌的診斷效能。結(jié)果:聯(lián)合評分的ROC的AUC(0.907,95%可信區(qū)間:0.871～0.942)均大于 TI-RADS 評分(0.763,95%可信區(qū)間:0.710～0.816)、彈性評分(0.745,95%可信區(qū)間:0.687～0.803)和造影評分(0.871,95%可信區(qū)間:0.828～0.913),前兩者差異有統(tǒng)計學(xué)意義(Z=4.438、4.630、1.269;P0.01、P0.01、P0.05)。聯(lián)合評分診斷敏感度、特異度和準(zhǔn)確度為0.908、0.754和0.853。FNAC聯(lián)合BRAF(V600E)基因突變診斷的敏感性、特異度和準(zhǔn)確度均為1.000,高于FNAC(0.966、0.956 和 0.962)。結(jié)論:多模態(tài)超聲影像能提高甲狀腺癌的診斷效能,進(jìn)一步篩選高危結(jié)節(jié)。FNAC是術(shù)前鑒別甲狀腺良惡性結(jié)節(jié)的金標(biāo)準(zhǔn),FNAC聯(lián)合BRAF(V600E)基因檢測可進(jìn)一步提高準(zhǔn)確性。
[Abstract]:The first part was qualitative and quantitative analysis of different sizes of thyroid nodules. Objective: to discuss the qualitative and quantitative analysis of different sizes of thyroid nodules. Methods: 178 patients with 178 thyroid nodules underwent ultrasound imaging before operation, all nodules were confirmed by hand pathology (74 benign, 104 malignant). The maximum diameter was divided into 2 groups (< < 1cm or 1 cm) and (1) qualitative assessment of the enhancement process of nodule contrast, degree, uniformity, non ring enhancement, enhanced boundary, shape and size of ultrasound contrast characteristics.Fisher accurate probability method compared the contrast between benign and malignant nodules by.ROC evaluation of the diagnostic value of thyroid sonography. (2) quantitative analysis The time intensity curve (TIC), the peak intensity (Peak), peak time (TtoPk) and the area under the curve (Area) were recorded in the nodular region of interest (ROI) and the parenchyma ROI, and the differences in the contrast parameters of the thyroid benign and malignant nodules were compared with the contrast-enhanced ultrasonography parameters of the nodular ROI minus the parenchyma ROI, Delta Area and other.T tests. Results: (1) C EUS showed that the degree of enhancement of thyroid benign and malignant nodules in 1cm and 1cm groups, process, uniformity, and the shape difference after intensification were statistically significant (P0.05), and the size after strengthening was not statistically significant (P0.001). Only 1cm thyroid nodules were strengthened, and the enhancement was complete, and the difference of ring shape was statistically significant (P0.05).ROC CEUS diagnosis 1 cm. The optimal threshold of thyroid benign and malignant nodules was 3.5, and the area under the curve was 0.869 (95% confidence interval 0.806 ~ 0.932) and 0.864 (95% confidence interval 0.717 to 1), and the sensitivity and specificity of CEUS in group 1cm were respectively 0.869, respectively, and the sensitivity and specificity of CEUS in group less 1cm were respectively 89.5%, 83.3%. (2) >1cm benign nodules Peak, and delta Area, respectively. Delta Peak and delta Grad are larger than malignant nodules (P=0.001, P=0.012, P=0.001, P=0.004). Peak, Delta Area and delta Grad are larger than malignant nodules (P=0.001, P=0.001, P=0.004). Conclusion: ultrasonography is helpful for differential diagnosis of thyroid nodules of different sizes. Ultrasound multimodality diagnosis in second parts of thyroid carcinoma Background: Ultrasonography (US) is the most sensitive method for the diagnosis of thyroid nodules, but it is difficult to differentiate between benign and malignant. US elastography (USE) and contrast-enhanced US (CEUS) are also used in clinical. Fine needle aspiration cytology (fine needle aspiration cytology) NAC) is the highest value of preoperative diagnosis of thyroid benign and malignant nodules, but there are still 20% to 25% nodules that cannot be diagnosed. Objective: To explore the value of US, USE, CEUS combined diagnosis, FNAC combined with BRAF (V600E) gene mutation in the diagnosis of thyroid cancer. Methods: 320 thyroid nodules in 275 patients underwent US, USE, CEUS and FNAC, confirmed by surgical pathology. There were 114 cases of benign and 206 malignant cases. Among them, 38 thyroid nodules (4 benign and 34 cases) were detected by BRAF gene. US, USE, CEUS and combined score ROC were plotted, and the area under the curve (the area under the ROC, AUC) was calculated and compared, and the joint scoring point was selected to calculate the diagnostic efficiency of the joint score. The efficacy of AF (V600E) gene mutation in the diagnosis of thyroid cancer. Results: the AUC (0.907,95% confidence interval: 0.871 ~ 0.942) of the combined score of ROC was greater than the TI-RADS score (0.763,95% confidence interval: 0.710 to 0.816), the elasticity score (0.745,95% confidence interval: 0.687 to 0.803) and the contrast score (0.871,95% confidence interval: 0.828 to 0.913), the difference between the former two Statistical significance (Z=4.438,4.630,1.269; P0.01, P0.01, P0.05). The sensitivity, specificity and accuracy of the combined score for diagnostic sensitivity, specificity and accuracy of 0.908,0.754 and 0.853.FNAC combined with BRAF (V600E) gene mutation were 1, higher than FNAC (0.966,0.956 and 0.962). Conclusion: multimodal ultrasound can improve thyroid cancer. The diagnostic efficiency and further screening of high risk nodules.FNAC are the gold criteria for preoperative identification of benign and malignant thyroid nodules. FNAC combined with BRAF (V600E) gene detection can further improve the accuracy.
【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.1;R581
，
本文編號：2150870
[Abstract]:The first part was qualitative and quantitative analysis of different sizes of thyroid nodules. Objective: to discuss the qualitative and quantitative analysis of different sizes of thyroid nodules. Methods: 178 patients with 178 thyroid nodules underwent ultrasound imaging before operation, all nodules were confirmed by hand pathology (74 benign, 104 malignant). The maximum diameter was divided into 2 groups (< < 1cm or 1 cm) and (1) qualitative assessment of the enhancement process of nodule contrast, degree, uniformity, non ring enhancement, enhanced boundary, shape and size of ultrasound contrast characteristics.Fisher accurate probability method compared the contrast between benign and malignant nodules by.ROC evaluation of the diagnostic value of thyroid sonography. (2) quantitative analysis The time intensity curve (TIC), the peak intensity (Peak), peak time (TtoPk) and the area under the curve (Area) were recorded in the nodular region of interest (ROI) and the parenchyma ROI, and the differences in the contrast parameters of the thyroid benign and malignant nodules were compared with the contrast-enhanced ultrasonography parameters of the nodular ROI minus the parenchyma ROI, Delta Area and other.T tests. Results: (1) C EUS showed that the degree of enhancement of thyroid benign and malignant nodules in 1cm and 1cm groups, process, uniformity, and the shape difference after intensification were statistically significant (P0.05), and the size after strengthening was not statistically significant (P0.001). Only 1cm thyroid nodules were strengthened, and the enhancement was complete, and the difference of ring shape was statistically significant (P0.05).ROC CEUS diagnosis 1 cm. The optimal threshold of thyroid benign and malignant nodules was 3.5, and the area under the curve was 0.869 (95% confidence interval 0.806 ~ 0.932) and 0.864 (95% confidence interval 0.717 to 1), and the sensitivity and specificity of CEUS in group 1cm were respectively 0.869, respectively, and the sensitivity and specificity of CEUS in group less 1cm were respectively 89.5%, 83.3%. (2) >1cm benign nodules Peak, and delta Area, respectively. Delta Peak and delta Grad are larger than malignant nodules (P=0.001, P=0.012, P=0.001, P=0.004). Peak, Delta Area and delta Grad are larger than malignant nodules (P=0.001, P=0.001, P=0.004). Conclusion: ultrasonography is helpful for differential diagnosis of thyroid nodules of different sizes. Ultrasound multimodality diagnosis in second parts of thyroid carcinoma Background: Ultrasonography (US) is the most sensitive method for the diagnosis of thyroid nodules, but it is difficult to differentiate between benign and malignant. US elastography (USE) and contrast-enhanced US (CEUS) are also used in clinical. Fine needle aspiration cytology (fine needle aspiration cytology) NAC) is the highest value of preoperative diagnosis of thyroid benign and malignant nodules, but there are still 20% to 25% nodules that cannot be diagnosed. Objective: To explore the value of US, USE, CEUS combined diagnosis, FNAC combined with BRAF (V600E) gene mutation in the diagnosis of thyroid cancer. Methods: 320 thyroid nodules in 275 patients underwent US, USE, CEUS and FNAC, confirmed by surgical pathology. There were 114 cases of benign and 206 malignant cases. Among them, 38 thyroid nodules (4 benign and 34 cases) were detected by BRAF gene. US, USE, CEUS and combined score ROC were plotted, and the area under the curve (the area under the ROC, AUC) was calculated and compared, and the joint scoring point was selected to calculate the diagnostic efficiency of the joint score. The efficacy of AF (V600E) gene mutation in the diagnosis of thyroid cancer. Results: the AUC (0.907,95% confidence interval: 0.871 ~ 0.942) of the combined score of ROC was greater than the TI-RADS score (0.763,95% confidence interval: 0.710 to 0.816), the elasticity score (0.745,95% confidence interval: 0.687 to 0.803) and the contrast score (0.871,95% confidence interval: 0.828 to 0.913), the difference between the former two Statistical significance (Z=4.438,4.630,1.269; P0.01, P0.01, P0.05). The sensitivity, specificity and accuracy of the combined score for diagnostic sensitivity, specificity and accuracy of 0.908,0.754 and 0.853.FNAC combined with BRAF (V600E) gene mutation were 1, higher than FNAC (0.966,0.956 and 0.962). Conclusion: multimodal ultrasound can improve thyroid cancer. The diagnostic efficiency and further screening of high risk nodules.FNAC are the gold criteria for preoperative identification of benign and malignant thyroid nodules. FNAC combined with BRAF (V600E) gene detection can further improve the accuracy.
【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.1;R581
，
本文編號：2150870
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