超音波檢查與現代細胞學分類（TBSRTC）於甲狀腺結節之診斷

Abstract

BACKGROUND: The purpose of this study was to compare relationships between thyroid ultrasound examinations, the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), and final pathology reports. We also discuss the management of thyroid nodules based on the results of ultrasound analysis and the classes of the Bethesda System. METHODS: We conducted a retrospective study that included patients who received ultrasound-guided fine-needle aspiration before thyroid surgery between July 2011 and July 2013 in department of otolaryngology. For each patient, we collected information related to age and gender, as well as records for ultrasound examination of thyroid nodules, fine-needle aspiration (Bethesda System), and pathology reports. RESULTS: Ultrasound features of benign and malignant thyroid nodules with statistically significant differences (p ＜ 0.01) included thyroid nodule margins (normal or irregular), presence or absence of hypo-echogenicity, architecture (solid or follicular), degree of calcification, and shape (e.g. ＂taller than wide＂; AP/TR ＞ 1). The malignant proportions of thyroid nodule in TBSRTC classes I through VI were 0% (0/5), 14% (6/44), 33% (3/9), 33% (1/3), 92% (12/13), and 100% (28/28), respectively. Additionally, we found that thyroid nodule margins provide the best sensitivity in diagnosing thyroid cancer (84%), and classes V and VI of the TBSRTC classification system have higher specificity (98.08%), positive predictive value (PPV; 97.56%), negative predictive value (NPV; 83.61%) and overall accuracy (89.22%) in diagnosing thyroid cancer. CONCLUSIONS: More specific ultrasound features of thyroid nodules with fine needle aspiration under ultrasound guidance can be used to identify high-grade malignant nodules for treatment. Physicians can manage the nodules based on ultrasound features and cytopathological reports from the Bethesda system.