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针道增强技术在甲状腺结节细针穿刺活检中使用效果的影响因素分析及预测模型建立
Influencing Factors and Prediction Model of Performance of Needle Visualization in Fine Needle Aspiration of Thyroid Nodules

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王亮凯 1,2   汤珈嘉 2   牛文全 1   贾欣颖 2   席雪华 2   马姣姣 2   李惠霖 2   孙哲 2   刘心怡 2   张波 2 *  
文摘 目的探究在甲状腺结节细针穿刺活检(FNA)过程中针道增强技术使用效果的影响因素,并建立预测模型对结节是否适合使用该技术做出预测。方法前瞻性纳入175例中日友好医院超声医学科行甲状腺结节FNA的患者,对199个结节使用针道增强技术前后针尖显示情况进行对比,记录使用针道增强前针尖显示不清结节的位置、与被膜的位置关系、超声特征以及穿刺部位软组织条索结构分布,并根据美国放射学会编订的甲状腺影像报告和数据系统进行风险分级。应用Lasso-Logistic回归筛选影响针道增强技术使用效果的因素并建立列线图预测模型。结果使用针道增强技术前135个(67.8%)结节针尖显示不清,使用后53个(26.6%)结节针尖显示不清,差异有统计学意义(P <0.001)。基于结节与被膜的位置关系、纵横比、血供以及穿刺部位皮下条索结构分布建立预测使用针道增强技术后针尖显示不清概率的列线图,其C指数为0.75(95%CI = 0.67~ 0.84),校准曲线拟合良好,受试者工作特征曲线下面积为0.72,内部验证C指数为0.70。结论针道增强技术在超声引导下甲状腺结节FNA中可提高针尖显示清晰度。基于结节与被膜的位置关系、纵横比、血供以及穿刺部位皮下条索结构分布构建的列线图可对结节是否适合使用针道增强技术进行预测。
其他语种文摘 Objective To investigate the influencing factors and establish a model predicting the performance of needle visualization in fine-needle aspiration (FNA) of thyroid nodules.Methods This study prospectively included 175 patients who underwent FNA of thyroid nodules in the Department of Ultrasound in China-Japan Friendship Hospital and compared the display of the needle tips in the examination of 199 thyroid nodules before and after the application of needle visualization.We recorded the location,the positional relationship with thyroid capsule,ultrasonic characteristics,and the distribution of the soft tissue strip structure at the puncture site of the nodules with unclear needle tips display before using needle visualization.Furthermore,according to the thyroid imaging reporting and data system proposed by the American College of Radiology,we graded the risk of the nodules.Lasso-Logistic regression was employed to screen out the factors influencing the performance of needle visualization and establish a nomogram for prediction.Results The needle tips were not clearly displayed in the examination of 135 (67.8%) and 53 (26.6%) nodules before and after the application of needle visualization,respectively,which showed a significant difference (P <0.001).Based on the positional relationship between the nodule and capsule,anteroposterior/transverse diameter (A/T) ratio,blood supply,and the distribution of subcutaneous strip structure at the puncture site,a nomogram was established to predict the probability of unclear display of the needle tips after application of needle visualization.The C-index of the prediction model was 0.75 (95%CI = 0.67-0.84) and the area under the receiver operating characteristic curve was 0.72.The calibration curve confirmed the appreciable reliability of the prediction model,with the C-index of 0.70 in internal validation.Conclusions Needle visualization can improve the display of the needle tip in ultrasound-guided FNA of thyroid nodules.The nomogram established based on ultrasound features such as the positional relationship between the nodule and capsule,A/T ratio,blood supply,and the distribution of subcutaneous strip structure at the puncture site can predict whether needle visualization is suitable for the examination of nodules.
来源 中国医学科学院学报 ,2023,45(3):366-373 【核心库】
DOI 10.3881/j.issn.1000-503X.15417
关键词 甲状腺结节 ; 针道增强 ; 超声引导下细针穿刺活检
地址

1. 中日友好临床医学研究所, 北京, 100029  

2. 中日友好医院超声医学科, 北京, 100029

语种 中文
文献类型 研究性论文
ISSN 1000-503X
学科 临床医学
基金 中央高水平医院临床科研业务费
文献收藏号 CSCD:7524760

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引证文献 1 篇

1 吴玮琦 超声低估甲状腺3类和4a类结节的细胞和组织病理表现 中国医学科学院学报,2025,47(1):23-28
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