超声弹性成像技术联合血清T...H检测对PTMC的诊断价值_谢丹虹.pdf

海南医学2023年4月第34卷第8期Hainan Med J,Apr.2023,Vol.34,No.8超声弹性成像技术联合血清TSH检测对PTMC的诊断价值谢丹虹，陈廷财，陈娟燕普宁市人民医院超声科，广东普宁515300【摘要】目的研究超声弹性成像技术联合血清促甲状腺激素(TSH)检测对甲状腺微小乳头状癌(PTMC)的诊断价值。方法选取2020年3月至2021年2月普宁市人民医院收治的50例行手术治疗的甲状腺微小结节患者作为观察组，另选取50例同期健康体检者作为对照组。两组受检者均行超声弹性成像技术检查，同时采用化学发光法(CL)检测血清TSH水平，以术后病理诊断作为金标准，采用受检者工作特征曲线(ROC)确定TSH水平最佳截点，分析超声弹性成像技术联合血清TSH诊断PTMC的敏感度、特异度，并比较所有受检者的血清TSH水平、良性和恶性结节的弹性成像评分。结果观察组患者经术后病理检查共检出137个结节，其中良性结节80个，恶性结节57个，超声弹性成像技术检出111个结节，其中65个良性结节，46个恶性结节，检出率为81.02%，与病理结果具有较高一致性。良性结节的超声弹性成像评分为(1.470.11)分，明显低于恶性结节的(3.190.26)分，差异有统计学意义(P0.05)；观察组中恶性结节患者的血清TSH水平为(2.910.24)mIU/L，良性结节患者为(2.280.33)mIU/L，明显高于对照组的(1.830.35)mIU/L，且与良性结节患者比较，恶性结节患者水平明显更高，差异均有统计学意义(P0.05)；经ROC分析结果显示，血清TSH联合超声弹性成像检测诊断PTMC的TSH最佳截点水平为2.16 mIU/L，其曲线下面积、检测敏感度、特异度以及约登指数均明显高于单独检测，差异均有统计学意义(P0.05)。结论超声弹性成像技术联合血清TSH检测诊断PTMC有较高临床价值，且联合诊断的价值更高，可将其作为诊断PTMC的重要指标和技术。【关键词】甲状腺微小乳头状癌；甲状腺；超声弹性成像技术；超声检查；促甲状腺激素；诊断价值【中图分类号】R736.1【文献标识码】A【文章编号】10036350（2023）08115204Diagnostic value of ultrasound elastography combined with serum thyroid-stimulating hormone detection forpapillary thyroid microcarcinoma.XIE Dan-hong,CHEN Ting-cai,CHEN Juan-yan.Department of Ultrasound,Peoples Hospital of Puning,Puning 515300,Guangdong,CHINA【Abstract】ObjectiveTo study the diagnostic value of ultrasound elastography combined with serum thy-roid-stimulating hormone(TSH)detection for papillary thyroid microcarcinoma(PTMC).MethodsFifty patients withthyroid nodules undergoing surgical treatment in Peoples Hospital of Puning from March 2020 to February 2021 wereselected as the observation group,and healthy subjects during the same period were selected as the control group.Bothgroups of subjects were examined by ultrasonic elastography and serum TSH level was detected by chemiluminescence(CL).Postoperative pathological diagnosis was regarded as the gold standard,and the working characteristic curve(ROC)of subjects was used to determine the best cutoff point of TSH level.The sensitivity and specificity of ultrasoundelastography combined with serum TSH in the diagnosis of thyroid nodules were analyzed,and the serum TSH level andelastography scores of benign and malignant nodules of all subjects were compared.ResultsA total of 137 noduleswere detected in the observation group through postoperative pathological examination,including 80 benign nodules and57 malignant nodules.A total of 111 nodules were detected by ultrasound elastography,including 65 benign nodules and46 malignant nodules,with the detection rate of 81.02%,which was highly consistent with the pathological results.The score of ultrasound elastography of benign nodules was(1.470.11)points,which was significantly lower than(3.190.26)points of malignant nodules(P0.05).The serum TSH level was(2.910.24)mIU/L in patients with malig-nant nodules and(2.280.33)mIU/L in patients with benign nodules in the observation group,which were significantlyhigher than(1.830.35)mIU/L in subjects in the control group;the level in patients with malignant nodules was signifi-cantly higher than that in patients with benign nodules;the differences were statistically significant(P0.05).The resultsof ROC analysis showed that the best cutoff level of TSH for the diagnosis of PTMC by serum TSH combined with ultra-sound elastography was 2.16 mIU/L,and its area under the curve,sensitivity,specificity,and Yoden index were signifi-cantly higher than those of individual detection,with statistically significant differences(P0.05).ConclusionUltra-sound elastography combined with serum TSH detection has a high diagnostic value for PTMC,which can be used as animportant indicator and technique to diagnose PTMC.【Key words】Papillary thyroid microcarcinoma;Thyroid;Ultrasound elastography;Ultrasound;Thyroid-stimulat-ing hormone;Diagnostic value 论著 doi:10.3969/j.issn.1003-6350.2023.08.018通讯作者：谢丹虹(1984)，女，副主任医师，主要研究方向为妇科疾病超声诊断相关，E-mail：。1152Hainan Med J,Apr.2023,Vol.34,No.8海南医学2023年4月第34卷第8期甲状腺微小乳头状癌(papillary thyroid microcarci-noma，PTMC)主要指原发肿瘤病灶直径10 mm的甲状腺癌，由于病灶较小且发病较为隐匿，早期也无特异性症状，同时常伴有甲状腺良性结节，常规超声诊断效果不甚理想1。超声弹性成像技术是在常规超声上发展而来的一种通过成像色彩差异辨别肿瘤组织硬度的检测技术，临床能通过分析弹性参数和分级确定肿瘤性质2。血清促甲状腺激素(TSH)与机体甲状腺功能变化密切相关，其水平分泌受甲状腺疾病的影响3。有研究指出，TSH水平变化与甲状腺癌的发生、进展关系密切4。本研究主要探讨超声弹性成像技术联合血清TSH检测对PTMC患者的诊断价值，现将结果报道如下：1资料与方法1.1一般资料选取2020年3月至2021年2月普宁市人民医院收治的50例(共137个结节)行手术治疗的甲状腺微小结节患者作为观察组。纳入标准：(1)均行甲状腺切除手术且经病理证实为微小甲状腺占位病变者；(2)肿瘤病灶直径0.05)，具有可比性。本研究经我院伦理委员会批准。1.2检查方法1.2.1超声弹性成像技术检查应用日立阿洛卡彩超二郎神超声诊断仪(HI VISION Preirus)进行检查，线阵探头配备频率范围为615 MHz。所有受检查者均取仰卧位，首先使用常规超声进行检查，主要观察结节的一般情况；之后调整为弹性成像模式，利用探头与肿瘤部位间的微小振动进行检查，探查区以病灶范围为中心向外扩展 23 倍，随时观察并注意仪器屏幕上所显示的压力指标，满格为适宜压力；弹性图像和二维图像均显示于屏幕上，对弹性图像进行彩色编码用以区分组织的不同弹性，组织较硬显示为蓝色，硬度平均显示为绿色，组织较软显示为红色。1.2.2血清TSH检测所有患者于清晨(入院次日)空腹抽取外周静脉血4 mL，离心(半径为8 cm，转速为3 500 r/min，时间为10 min)分离血清后送检，采用化学发光法进行检测，全部操作均严格按照说明书进行。TSH水平正常范围为0.345.60 mIU/L。1.2.3术后病理学检查所有受检查者均经术后病理学检查确诊。术后病理检查内容包含：结节最大直径、病理分型、有无淋巴转移、有无包膜外侵犯、淋巴结位置及数目。恶性肿瘤分期采用美国癌症联合委员会制定的TNM分期标准5。1.3弹性图像评分标准6弹性图像显示肿瘤周围组织与肿瘤病灶全部呈绿色为1级，评分1分；弹性图像显示周围组织与病灶大部分是绿色(面积50%)为2级，评分2分；弹性图像显示周围组织与病灶主要是蓝色(面积50%90%)为3级，评分3分；弹性图像显示周围组织与病灶基本是蓝色(面积