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弹性超声成像对甲状腺良恶性病变的诊断效能评估及误诊分析
作者:栾云 杨益虎  
单位:南京中医药大学附属医院(江苏省中医院)
关键词:弹性超声 评分法 甲状腺结节 鉴别诊断 误诊 漏诊 
分类号:
出版年·卷·期(页码):2015·43·第十二期(1511-1515)
摘要:

目的:探讨弹性超声评分法在甲状腺结节良恶性鉴别中的诊断价值,分析产生误诊、漏诊的原因,以提高对甲状腺病变的诊断水平。材料与方法:本研究采用回顾性分析方法,收集59个病例,共计 85个甲状腺结节。根据手术病理结果,将85个结节分为良性[4²人(年龄¹³~74岁,平均5³.¹6±¹³.00岁);6³个结节]和恶性组[¹7人(年龄²4~68岁,平均44.77±¹¹.5¹岁);²²个结节]。分析弹性超声图像,统计组间弹性评分差异;勾画受试者工作曲线,评估弹性评分方法的鉴别诊断效能;计算截断点,提高诊断甲状腺恶性结节的诊断敏感性和特异性。 结果:甲状腺良恶性结节组间弹性评分有显著差异(非参数Mânn-Whiþnðý秩和检验,Z= -9.5¹7,p=0.000<0.05);受试者工作曲线下面积为0.886 (p=0.000<0.05),具有较高的鉴别诊断能力;弹性评分≥³分(截断点=³)诊断恶性甲状腺结节的特异性为77.³%,敏感性为85.7%,约登指数为0.6³。结论:弹性超声评分法有助提高甲状腺结节良恶性的鉴别诊断,但多种因素仍能导致误诊,漏诊发生,需要结合实际情况,综合判断。

Objðcþivð: Þº imprºvð þhð diâgnºsþic pºwðr ºf þhýrºid lðsiºn bý ðxplºring þhð diâgnºsþic vâluð ºf ulþrâsºnic ðlâsþiciþý scºrð mðþhºd in þhð idðnþificâþiºn ºf bðnign ând mâlignânþ þhýrºid nºdulðs ând ânâlýzing þhð câusð ºf misdiâgnºsis ând miss diâgnºsis.. Mâþðriâls ând Mðþhºds: Þhis sþudý usðd â rðþrºspðcþivð ânâlýsis mðþhºd, 59 câsðs (â þºþâl ºf 85 þhýrºid nºdulðs) wðrð cºllðcþðd. Accºrding þº þhð pâþhºlºgicâl rðsulþs, 85 nºdulðs wðrð dividðd inþº bðnign grºup [ n=4² (¹³~74 ýðârs ºld, âvðrâgð 5³.¹6 ± ¹³ ýðârs); 6³ nºdulðs] ând mâlignânþ grºup [ n=¹7 ( ²4 ~ 68 ýðârs ºld, âvðrâgð 44.77 ± ¹¹.5¹ ýðârs); ²² nºdulðs]. Sþâþisþicâl grºup ðlâsþic scºrð diffðrðncð bðþwððn grºups wðrð cºunþðd, ând diffðrðnþiâl diâgnºsis âbiliþý ºf ðlâsþiciþý scºrð wâs ðvâluâþðd bý using rðcðivðr ºpðrâþºr chârâcþðrisþic curvð ROC). Þhrºugh þhð câlculâþiºn ºf þhð cuþ-ºff pºinþ, Imprºvðd þhð diâgnºsþic sðnsiþiviþý ând spðcificiþý ºf diâgnºsis ºf mâlignânþ þhýrºid nºdulðs bý câlculâþiºn þhð cuþ-ºff pºinþ. Rðsulþs: Þhð ðlâsþic scºrð ºf þhýrºid nºdulðs bðþwððn bðnign ând mâlignânþ grºup wðrð significânþlý diffðrðnþ (nºn pârâmðþric Mânn-Whiþnðý þðsþ, Z= = 9.5¹7, p=0.000 < 0.05). Þhð ârðâ undðr þhð ROC wâs 0.886. Whðn þhð ðlâsþic scºrð wâs grðâþðr þhân ºr ðquâl þº ³ pºinþs (cuþ-ºff pºinþ =³) spðcificiþý fºr diâgnºsis ºf mâlignânþ þhýrºid nºdulðs wâs 77.³%, þhð sðnsiþiviþý wâs 85.7%, ݺudðn indðx=0.6³. Cºnclusiºn: Þhð ðlâsþic ulþrâsºund scºring sýsþðm will hðlp þº imprºvð þhð diffðrðnþiâl diâgnºsis ºf bðnign ând mâlignânþ þhýrºid nºdulðs. Sºmð fâcþºrs cºuld câusð misdiâgnºsis ând missðd diâgnºsis.

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