超声造影联合弹性成像鉴别TBSRTCIII~V类甲状腺结节良恶性的临床价值

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ABSTRACTObjectiveTo explore the clinical value of contrast-enhanced ultrasound（CEUS）combined with ultrasound elastography（UE）indifferentiatingbenignandmalignantthyroidnodulesclasifiedastheBethesda Systemfor Reporting Thyroid Cytopathology（TBSRTC）Il-V.MethodsA total of 120 patients with thyroid nodules（136 nodules in total，including 88 malignant and 48 benign）diagnosedas TBSRTC ||-V by fine-needle aspiration cytology（FNAC）in our hospital were selected.Before surgery，CEUS was performed toobserve the enhancementpattrn，degreeof enhancement， washout characteristics，andthepresenceofcomplete enhancementring.UEwas used toobtain UEscores.The diferences in aboveexaminationresultsbetweenbenignandmalignantnoduleswerecompared.Takingpostoperativepathologicalresultsasthe goldstandard，theconsistencybetween CEUS，UE，andtheircombinationandpathologicalresultsindiferentiating benignand malignant TBSRTC ||-V thyroid nodules was analyzed.Receiver operating characteristic （ROC） curves were drawn to analyze thediagnostic efficacyof CEUS，UE，and theircombined application in diferentiating benignand malignant TBSRTC h-V （204 thyroid nodules.ResultsTherewerestatisticallysignificantdiferences inenhancement pattrn，degreeofenhancement， washout characteristics，thepresenceofcompleteenhancementring，and UEscores betweenbenignandmalignant nodules（all P<0.001 ）.The diagnostic accuracies of CEUS and UE in diferentiating benign and malignant TBSRTC ||-V thyroid nodules were 86.76% and 86.03% ，respectively，with moderate agreement with postoperative pathological results （Kappa=O.728，0.714， both P <0.05）.The combination ofCEUS and UE achieved a diagnostic accuracyof 94.85% in differentiating benign and malignant TBSRTC |-V thyroid nodules，with good agreement with postoperative pathological results （Kappa=0.889， P <0.05）. ROC curveanalysisshowed thatthe AUCsofCEUS，UE，and their combined application for diferentiating benignand malignant TBSRTC |-ΔV thyroid nodules were 0.888，0.883，and 0.951，respectively.The AUCof the combined application was higher than that of individual application，and the differences were statistically significant （all P<0.05 ）.Conclusion CEUS combinedwith UEcanimprovethediagnosticaccuracyindifferentiatingbenignandmalignantTBSRTCII-Vthyroidnodules， demonstrating good clinical value.

KEYWORDSUltrasonography; Contrastagent; Ultrasound elastography;TheBethesda SystemforReporting Thyroid Cytopathology;Thyroid nodule，benignand malignant

甲状腺细胞病理学Bethesda报告系统（TBSRTC）分为I～VI级，其中 I～V 级病变的恶性风险跨度大，约 10%～75% ，因此准确鉴别TBSRTCII～V类甲状腺结节良恶性尤为重要[1]。（剩余7064字）