血清Tg、TSH结合超声检查在分化型甲状腺癌患者术前诊断中的应用价值

Application Value of Serum Tg and TSH Combined with Ultrasound in Preoperative Diagnosis of Patients with Differentiated Thyroid Carcinoma

摘要: 分化型甲状腺癌(DTC)的术前精准诊断对治疗策略制定及预后评估至关重要。超声检查作为首选影像学手段，通过评估结节形态、边界、回声特征(如低回声、微钙化)及血流参数提供重要诊断信息，但其准确性受操作者经验及病灶复杂性影响。血清甲状腺球蛋白(Tg)在DTC患者中常显著升高，但特异性受良性病变及TgAb干扰；促甲状腺激素(TSH)水平与DTC风险呈正相关，但单独预测价值有限。研究表明，三者联合应用可显著提升诊断效能：超声联合Tg、TSH鉴别T分期的灵敏度达84.15%、特异度97.62% (AUC = 0.939)，鉴别N分期的灵敏度80.60%、特异度96.49% (AUC = 0.947)。多模态联合策略整合了影像学与血清学优势，为DTC术前诊断提供了更可靠的依据，具有重要临床应用价值。

Abstract: Precise preoperative diagnosis of differentiated thyroid carcinoma (DTC) is critical for formulating treatment strategies and evaluating prognosis. Ultrasound, as the primary imaging modality, provides essential diagnostic information by assessing nodule morphology, margins, echogenicity (e.g., hypoechoicity, microcalcifications), and hemodynamic parameters. However, its accuracy is influenced by operator experience and lesion complexity. Serum thyroglobulin (Tg) is often significantly elevated in DTC patients, but its specificity is limited by benign lesions and TgAb interference. Thyroid-stimulating hormone (TSH) levels are positively correlated with DTC risk, yet its standalone predictive value remains limited. Studies demonstrate that combining ultrasound with Tg and TSH significantly improves diagnostic efficacy: for T-stage differentiation, sensitivity reaches 84.15%, specificity 97.62% (AUC = 0.939); for N-stage differentiation, sensitivity is 80.60%, specificity 96.49% (AUC = 0.947). This multimodal approach integrates imaging and serological advantages, offering a more reliable basis for preoperative DTC diagnosis and substantial clinical utility.