US-FNA联合CK-19、TPO检测对C-TIRADS 4A/4B分类甲状腺结节的诊断价值

Diagnostic value of US-FNA combined with CK-19 and TPO for C-TIRADS 4A/4B thyroid nodules

摘要:

目的 探究超声引导下细针穿刺（US-FNA）联合细胞角蛋白（CK-19）、甲状腺过氧化物酶抗体（TPO）检测对C-TIRADS 4A/4B分类甲状腺结节的诊断价值。方法 选取2021年4月—2023年4月在西南医科大学附属中医医院治疗的98例甲状腺结节患者，共纳入123个结节，患者均接受术后病理检查，结节良恶性诊断明确。所有患者行US-FNA检查，采用免疫组织化学MaxiVision两步法检测CK-19、TPO表达。结果 98例（123个）结节中，术后病理检查诊断良性结节87个（70.73%），恶性36个（29.27%）。经US-FNA诊断，恶性结节以Ⅴ类为主，为52.78%（19/36），良性结节以Ⅱ类为主，为56.32%（49/87）。恶性结节的CK-19阳性表达率、TPO阴性表达率均高于良性结节（P <0.05）。以术后病理检查为金标准，123个结节经US-FNA检查漏诊13个，误诊3个；经CK-19检查，漏诊7个，误诊11个；经TPO检查，漏诊10个，误诊13个；联合诊断漏诊9个，误诊2个。US-FNA检查诊断甲状腺结节恶性的准确率为86.99%，敏感性为88.5%（95% CI：0.824，0.941），特异性为86.6%（95% CI：0.807，0.925）；CK-19诊断甲状腺结节恶性的准确率为85.37%，敏感性为72.5%（95% CI：0.665，0.785），特异性为91.6%（95% CI：0.866，0.965）；TPO诊断甲状腺结节恶性的准确率为81.30%，敏感性为66.7%（95% CI：0.585，0.749），特异性为88.1%（95% CI：0.823，0.939）；联合诊断甲状腺结节恶性的准确率为91.06%，敏感性为75.0%（95% CI：0.677，0.823），特异性为97.7%（95% CI：0.937，0.997）。结论 US-FNA联合CK-19、TPO检测对C-TIRADS 4A/4B分类甲状腺结节的诊断价值较高，能显著提高其诊断的准确性和特异性，值得临床推广。

Abstract:

Objective To explore the diagnostic value of ultrasound-guided fine needle aspiration (US-FNA) combined with levels of cytokeratin-19 (CK-19) and thyroid peroxidase antibody (TPO) for thyroid nodules classified as 4A/4B via C-TIRADS.Methods Ninety-eight patients with thyroid nodules treated in our hospital from April 2021 to April 2023 were selected, and a total of 123 thyroid nodules were included for the study. All thyroid nodules were pathologically examined to determine the malignancy. All patients received US-FNA, and the expressions of CK-19 and TPO were detected via immunohistochemistry.Results Among 123 thyroid nodules from 98 cases, 87 (70.73%) were diagnosed as benign nodules according to the pathological findings. The other 36 thyroid nodules were diagnosed as malignant, accounting for about 29.27%. As indicated by US-FNA, the majority of malignant nodules were of class V, accounting for 52.78% (19/36). In contrast, the majority of benign nodules were of class II, accounting for 56.32% (49/87). The positive expression rates of CK-19 and TPO in malignant thyroid nodules were higher than those in benign thyroid nodules (P < 0.05). With postoperative pathological results as the gold standard, 13 of the 123 thyroid nodules were missed and 3 were misdiagnosed by US-FNA. In light of CK-19 positivity for diagnosing thyroid nodules, 7 were missed and 11 were misdiagnosed. By TPO positivity, 10 were missed and 13 were misdiagnosed. The combined detection of them led to 9 cases of missed diagnosis and 2 cases of misdiagnosis. The accuracy, sensitivity and specificity of US-FNA for diagnosing malignant thyroid nodules were 86.99%, 88.5% (95% CI: 0.824, 0.941) and 86.6% (95% CI: 0.807, 0.925), those of CK-19 85.37%, 72.5% (95% CI: 0.665, 0.785) and 91.6% (95% CI: 0.866, 0.965), those of TPO 81.30%, 66.7% (95% CI: 0.585, 0.749), and 88.1% (95% CI: 0.823, 0.939), and those of the combined detection 91.06%, 75.0% (95% CI: 0.677, 0.823) and 97.7% (95% CI: 0.937, 0.997), respectively.Conclusions US-FNA combined with CK-19 and TPO detection exhibits a high diagnostic value for thyroid nodules classified as 4A/4B by C-TIRADS, and significantly increases the diagnostic accuracy and specificity, thereby being valuable for extensive application in clinical practice.