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目的探讨甲状腺结节超声特征参数大小、钙化对超声引导下细针穿刺抽吸(ultrasound-guided fine-needle aspiration,US-FNA)诊断效能的影响。方法回顾性分析2012~2014年行US-FNA的614例患者,根据结节最大径分为A组(≤5 mm)、B组(5~10 mm)、C组(>10 mm),以及根据钙化类型分为N组(无钙化)、Mi组(微钙化)、Ma组(粗钙化)。以Bethesda System评估US-FNA结果,同时应用受试者工作特征曲线(ROC)评价诊断效果。结果 1A组FNA诊断甲状腺癌敏感性、特异性、准确率、阳性预测值、阴性预测值分别为92.1%、96.6%、94.0%、97.2%、90.3%;B组分别为91.1%、95.3%、93.0%、96.3%、89.1%;C组分别为93.6%、96.2%、95.1%、94.8%、95.2%,3组间敏感性、特异性、准确率、阳性预测值、阴性预测值比较差异均无统计学意义(P>0.05)。N组FNA诊断甲状腺癌敏感性、特异性、准确率、阳性预测值、阴性预测值分别为90.9%、96.3%、93.6%、96.3%、90.9%;Mi组分别为93.5%、92.1%、93.0%、95.1%、89.7%;Ma组分别为96.6%、97.1%、96.8%、96.6%、97.1%,3组间各值比较差异均无统计学意义(P>0.05)。2A、B、C组的ROC曲线下面积AUC分别为0.94、0.93、0.95,N、Mi、Ma组分别为0.94、0.93、0.97。结论 US-FNA对于大小不限、有无钙化的甲状腺结节均具有较高的诊断价值。
Objective To investigate the effect of ultrasonographic parameters of thyroid nodules on the diagnostic efficacy of ultrasound-guided fine-needle aspiration (US-FNA). Methods A total of 614 patients with US-FNA between 2012 and 2014 were retrospectively analyzed. According to the maximum diameter of nodules, they were divided into group A (≤5 mm), group B (5-10 mm), group C (> 10 mm) According to the type of calcification is divided into N group (no calcification), Mi group (micro-calcification), Ma group (coarse calcification). The US-FNA results were evaluated using the Bethesda System, and the diagnostic performance was evaluated using the receiver operating characteristic curve (ROC). Results The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FNA in group A were 92.1%, 96.6%, 94.0%, 97.2% and 90.3%, respectively; those in group B were 91.1% and 95.3% 93.0%, 96.3% and 89.1% respectively in group C, 93.6%, 96.2%, 95.1%, 94.8% and 95.2% in group C. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the three groups were No statistical significance (P> 0.05). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FNA in N group were 90.9%, 96.3%, 93.6%, 96.3% and 90.9% respectively for the thyroid cancer group and 93.5%, 92.1% and 93.0% for the Mi group %, 95.1%, and 89.7% respectively. There was no significant difference between the three groups (96.6%, 97.1%, 96.8%, 96.6% and 97.1%, respectively) in Ma group (P> 0.05). The area under the ROC curve of A, B, C groups were 0.94, 0.93, 0.95, and 0.94, 0.93 and 0.97 respectively for the M and Ma groups. Conclusion US-FNA has high diagnostic value for thyroid nodules of any size and calcification.