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目的探讨甲状腺微小肿瘤鉴别诊断的简便有效的检查方法。方法对泰安市中小学老师650人行甲状腺常规扫查,同时进行弹性成像(UE)检查,并以病理结果为金标准,观察甲状腺微小肿瘤的流行病学结果。结果筛选出56例有甲状腺微小包块的患者(结节共81个),直径均<1 cm,其中男性16例,28个结节,女性40例,53个结节。根据约登指数计算当最大约登指数为0.82时,应变率(SR)比值的最佳诊断切点为3.36,以SR比值>3.36诊断结节为恶性,SR比值≤3.36诊断为良性。常规超声扫查对泰安市中小学教师样本中甲状腺微小肿瘤良恶性诊断,其特异性、敏感度和准确性分别为76.76%、80.38%、79.66%;而甲状腺常规扫查结合UE诊断甲状腺良恶性病变的特异度、敏感度和准确性分别为96.67%、90.48%、95.06%,两组间比较差异有统计学意义(P<0.05)。结论常规超声扫查结合UE应变率比值法是鉴别甲状腺微小肿瘤良恶性简便的无创、经济的检查方法。
Objective To explore a simple and effective method for the differential diagnosis of thyroid micrometastasis. Methods 650 primary and secondary school teachers in Tai’an were routinely scanned thyroid gland, and elastography (UE) was performed at the same time. The pathological results were taken as gold standard to observe the epidemiological results of thyroid micrometastasis. Results Fifty-six patients with nodular thyroid mass (81 nodules) were screened, all with a diameter of less than 1 cm. There were 16 males, 28 nodules, 40 females and 53 nodules. According to the Youden index, when the maximum Youden index is 0.82, the best diagnostic cut point of the strain rate (SR) ratio is 3.36, the malignancy of the diagnosis nodules with the SR ratio> 3.36 and the benignity of the SR ratio ≤3.36. The specificity, sensitivity and accuracy of conventional ultrasonography in the diagnosis of benign and malignant thyroid tumors in primary and secondary school teachers in Tai’an were 76.76%, 80.38% and 79.66%, respectively; while thyroid routine scan combined with the diagnosis of benign and malignant thyroid in UE The specificity, sensitivity and accuracy of the lesions were 96.67%, 90.48% and 95.06%, respectively, with significant difference between the two groups (P <0.05). Conclusion Conventional ultrasound scan combined with UE strain ratio method is a simple, noninvasive and economical method to identify benign and malignant thyroid tumors.