目的：探讨甲状腺结节的超声纵横比（Anteroposterior/transverse diameter ratio，A/T）与大体组织A/T的异同，分析超声A/T在甲状腺结节定性诊断中的价值。方法：分析经手术及病理证实的80例85枚甲状腺结节的超声征象，测量A/T（横切和纵切），并与术后大体组织的纵切A/T进行对照，观察甲状腺良恶性结节的超声A/T、大体组织A/T，分析超声A/T>1在甲状腺乳头状癌（Papillary thyroid carcinoma，PTC）中的敏感性、特异性、阳性预测值、准确度。结果：85枚甲状腺结节中，60枚PTC，25枚结节性甲状腺肿（Nodular goiter，NG）。60枚PTC中，27枚超声纵切A/T>1，8枚大体组织纵切A/T>1，8枚超声与大体组织同时A/T>1；25枚NG中，4枚超声纵切A/T>1，2枚大体组织A/T>1，1枚超声与大体组织同时A/T>1。超声纵切与实际大体组织纵切A/T>1符合比为33.33%（9/27），超声纵切与实际大体组织纵切A/T≤1符合比为98.27%（57/58）。超声纵切A/T>1在PTC中的敏感性、特异性、阳性预测值、准确度分别为45.00%、84.00%、87.09%、56.47%，超声纵切或横切A/T>1在PTC中的敏感性、特异性、阳性预测值、准确度分别为61.66%、84.00%、90.24%、68.24%。结论：虽然甲状腺结节的超声A/T与大体组织A/T之间存在很大差异，但超声A/T>1仍然是判断PTC的重要依据，超声纵切与横切A/T联合应用可以提高PTC诊断的敏感性、阳性预测值和准确度。
Abstract
Objective: To evaluate the diagnostic value of anteroposterior/transverse diameter ratio(A/T) in cases with thyroid nodules by comparing the A/T values between ultrasonography and gross tissue. Methods: The ultrasonic findings of 85 thyroid nodules in 80 cases confirmed by surgery and pathology were analysed. The A/T values in ultrasonographic transverse and longitudinal planes were measured and compared with the A/T values in the postoperative gross tissue longitudinal plane. The A/T values in ultrasonography and gross tissue of benign and malignant thyroid nodules were observed, and the sensitivity, specificity, positive predictive value and accuracy of A/T>1 in ultrasonography in papillary thyroid carcinomas(PTC) were analysed. Results: Of 85 thyroid nodules, 60 nodules were diagnosed as PTC, the remaining as nodular goiter(NG). Among 60 nodules with PTC, there were 27 nodules with A/T>1 in ultrasonographic longitudinal plane, 8 nodules with A/T>1 in gross tissue longitudinal plane, and 8 nodules with A/T>1 in both ultrasonography and gross tissue. Among 25 nodules with NG, 4 nodules with A/T>1 in ultrasonographic longitudinal plane were found, 2 nodules with A/T>1 in gross tissue, and only 1 case with A/T>1 in both ultrasonography and gross tissue. The coincidence rate of A/T>1 in ultrasonographic and gross tissue longitudinal planes was only 33.33%(9/27), but the coincidence rate of A/T≤1 was 98.27%(57/58). The sensitivity, specificity, positive predictive value and accuracy of A/T>1 in ultrasonographic longitudinal plane in the diagnosis of PTC were 45.00%, 84.00%, 87.09% and 56.47% respectively. The sensitivity, specificity, positive predictive value and accuracy of A/T>1 in ultrasonographic transverse or longitudinal plane in the diagnosis of PTC were 61.66%, 84.00%, 90.24% and 68.24% respectively. Conclusions: There is a large difference in A/T between ultrasonography and gross tissue in thyroid nodules, but A/T>1 in ultrasonography remains an important basis for the judgment of the PTC, the combined application of A/T in ultrasonographic transverse and longitudinal planes can improve the sensitivity, positive predictive value and accuracy of diagnosis of PTC.
关键词
甲状腺结节；超声检查 /
多普勒 /
彩色
Key words
Thyroid nodule /
Ultrasonography, Doppler, color
中图分类号：
Ｒ736.1
Ｒ581
R445.1
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基金
杭州市医药卫生科技计划项目（编号：2012A020，2014A02）；杭州市重大科技创新专项项目（编号：20131813A08）。
