探讨声辐射力脉冲弹性成像技术声触诊组织成像（VTI）技术和声触诊组织定量（VTQ）技术在鉴别诊断浅表肿大淋巴结良恶性中的应用价值。

收集2013年10月至2014年3月于汕头大学医学院第一附属医院就诊的全身浅表淋巴结肿大患者41例，共50个淋巴结。其中非特异性炎症性淋巴结23个，结核性淋巴结2个，淋巴瘤5个，转移性淋巴结20个。所有淋巴结均经活检病理或抗炎治疗后随访证实。所有淋巴结于术前或治疗前均行常规超声、VTI及VTQ检查。绘制常规超声、VTI技术、VTQ技术鉴别诊断浅表肿大淋巴结良恶性的操作者工作特征（ROC）曲线，确定常规超声、VTI技术、VTQ技术鉴别诊断浅表肿大淋巴结良恶性的最佳界值，计算相应的敏感度、特异度、准确性、阳性预测值、阴性预测值。以最终诊断结果作为金标准，计算联合应用常规超声、VTI、VTQ技术鉴别诊断浅表肿大淋巴结良恶性的敏感度、特异度、准确性、阳性预测值、阴性预测值。

ROC曲线显示，以淋巴结二维灰阶超声结合彩色多普勒评分=9分为最佳界值，常规超声鉴别诊断浅表肿大淋巴结良恶性的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为76.0%、84.0%、80.0%、82.6%、77.8%；以VTI分级=3级为最佳界值，VTI技术鉴别诊断浅表肿大淋巴结良恶性的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为88.0%、64.0%、76.0%、71.0%、84.2%；以SWV值=2.755 m/s为最佳界值，VTQ技术鉴别诊断浅表肿大淋巴结良恶性的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为80.0%、92.0%、86.0%、90.9%、82.1%。定义常规超声+VTI+VTQ串联法为常规超声、VTI技术、VTQ技术同时诊断为恶性浅表淋巴结才能确诊为恶性，否则为良性；定义常规超声+VTI+VTQ并联法为常规超声、VTI技术、VTQ技术中的一种方法诊断为恶性浅表淋巴结即确诊为恶性，否则为良性；常规超声+VTI+VTQ串联法鉴别诊断浅表肿大淋巴结良恶性的特异度与VTQ技术一致，达到92.0%，而敏感度、准确性较单纯应用常规超声、VTI技术、VTQ技术均明显下降，分别为64.0%、78.0%；常规超声+VTI+VTQ并联法鉴别诊断浅表肿大淋巴结良恶性的敏感度及阴性预测值均较单纯应用常规超声、VTI技术、VTQ技术明显提高，达到100%，但特异度、准确性则均较单纯应用常规超声、VTI技术、VTQ技术有所下降，分别为64.0%、82.0%。

常规超声、VTI技术及VTQ技术对鉴别诊断浅表肿大淋巴结的良恶性均有一定的临床价值。联合应用常规超声、VTI技术及VTQ技术能有效提高浅表肿大淋巴结良恶性鉴别诊断的准确性。

To investigate the application value of virtual touch tissue image technology (VTI) and virtual touch tissue quantification technique (VTQ) in the differential diagnosis of benign and malignant superficial lymph nodes.

Fifty superficial lymph nodes were obtained, including 23 for nonspecific inflammatory, 2 for tuberculosis, 5 for lymphoma and 20 for metastasis. All lymph nodes were confirmed by biopsy pathology or follow-up after anti-inflammatory treatments and scanned by traditional ultrasound, VTI and VTQ before resections or treatments. Receiver operating characteristic curve of traditional ultrasound, VTI and VTQ was made to determine the optional cut-off point in the differential diagnosis of benign and malignant superficial lymph nodes and calculate the sensitivity, specificity, accuracy, positive predictive value and negative predictive value. Final diagnosis was defined as the golden standard. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated by the combined application of traditional ultrasound with VTI and VTQ technology.

Nine (evaluation value) was taken as the critical value which was scanned by both two-dimensional ultrasound and color Doppler. The ROC curve indicated that the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of conventional two-dimensional ultrasound of benign and malignant lymph nodes were 76.0%, 84.0%, 80.0%, 82.6%, and 77.8%. Taking three (critical value) as the cut-off point, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of VTI in the diagnosis of benign and malignant lymph nodes were 88.0%, 64.0%, 76.0%, 71.0% and 84.2%. Taking 2.755 m/s (shear wave velocity) as the cut-off value, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of VTQ in the differentiation of benign and malignant superficial lymph nodes were 80%, 92.0%, 86.0%, 90.9% and 82.1%. Defined "traditional ultrasound +VTI+VTQ series method" as using conventional ultrasound, VTI, VTQ simultaneously, superficial lymph nodes could be diagnosed with malignant or benign if each method confirmed the same diagnosis. Defined "traditional ultrasound +VTI+VTQ parallel method" as using conventional ultrasound, VTI, VTQ simultaneously, superficial lymph nodes could be diagnosed with malignant if any one method indicated malignancy, otherwise benign. Specificity of 'traditional ultrasound +VTI+VTQ series method’ was consistent with VTQ, which was 92.0%, while the sensitivity and accuracy decreased significantly, which was 64.0% and 78.0%, respectively; the sensitivity and negative predictive value increased significantly by using "traditional ultrasound +VTI+VTQ parallel method" when compared with traditional ultrasound, VTI or VTQ, almost near 100%, but declined significantly in specificity and accuracy, which was 64.0% and 82.0%, respectively.

Traditional ultrasound, VTI and VTQ have certain clinical value for differential diagnosis of benign and malignant superficial lymph nodes. Combined application of traditional ultrasound, VTI and VTQ can improve the accuracy in the diagnosis of benign and malignant lymph nodes effectively.