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目的探讨超声联合Galectin-3、CK19诊断甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的准确性。方法收集甲状腺结节病例150例,其中PTC 66例分为PTC组,结节性甲状腺肿(nodular goiter,NG)84例分为NG组。对两组的超声特征进行比较;以病理组织的检测为标准,分析以FNAC的标本检测CK19和Galectin-3的表达情况的敏感度、特异性和准确性;应用ROC曲线统计分析患者结节的TI-RADS分类、CK19和Galectin-3的表达分级的情况,比较超声、CK19、Galectin-3单独或联合诊断PTC的ROC曲线下面积(area under curve,AUC),分析约登指数最高时的敏感度和特异性。结果 PTC组出现边界不清、内部回声低、微钙化以及血流达3级的超声特征均较NG组显著,差异有统计学意义(P<0.05);FNAC检测CK19、Galectin-3表达的的敏感度、特异性、准确性分别为90.16%、87.50%、89.51%和87.85%、87.270%、87.65%。单独超声、CK19或Galectin-3诊断NG、PTC的AUC分别为0.846、0.829、0.785,三者诊断效能均为中等水平;而联合超声、CK19和Galectin-3诊断NG和PTC的AUC为0.904,诊断效能较高,其敏感度为83.3%、特异性为79.6%时约登指数可达0.629。结论术前对超声引导穿刺的标本进行CK19和Galectin-3表达强度的检测结合超声检查结果有助于提高对于PTC和NG的鉴别和诊断。
Objective To investigate the diagnostic accuracy of ultrasound combined with Galectin-3 and CK19 in the diagnosis of papillary thyroid carcinoma (PTC). Methods A total of 150 cases of thyroid nodules were collected. Among them, 66 cases were divided into PTC group and 84 cases with nodular goiter (NG). The sensitivity, specificity and accuracy of detecting the expression of CK19 and Galectin-3 by FNAC were analyzed by using the pathological tissue as the standard. The ROC curve was used to analyze the nodules TI-RADS classification, CK19 and Galectin-3 expression grade were compared with ultrasound, CK19, Galectin-3 alone or in combination with PTC area under curve (AUC), the sensitivity analysis of the highest Youden index Degree and specificity. Results The ultrasonographic features of unclear boundary, low internal echo, micro-calcification and blood flow in grade 3 were significantly higher in PTC group than those in NG group (P <0.05). The expression of CK19 and Galectin-3 in FNAC Sensitivity, specificity and accuracy were 90.16%, 87.50%, 89.51% and 87.85%, 87.270% and 87.65% respectively. Ultrasound alone, CK19 or Galectin-3 diagnosis of NG, PTC AUC were 0.846,0.829,0.785, the diagnostic efficacy of the three were moderate; and combined ultrasound, CK19 and Galectin-3 diagnosis of NG and PTC AUC was 0.904, the diagnosis Higher performance, the sensitivity was 83.3%, the specificity of 79.6% when the Youden index up to 0.629. Conclusion The preoperative ultrasound guided puncture specimens CK19 and Galectin-3 expression intensity combined with ultrasound examination results help to improve the identification and diagnosis of PTC and NG.