探讨甲状腺微小结节位置对其良恶性鉴别的辅助价值。

回顾性分析2018年1月至2020年11月于兰州大学第二医院就诊并经病理证实的426个甲状腺微小结节在不同切面的定位及其超声特征，采用二元Logistic回归分析预测甲状腺癌的独立危险因素，绘制受试者操作特征（ROC）曲线，比较单纯美国放射学会甲状腺影像报告与数据系统（ACR TI-RADS）分级及结节位置联合ACR TI-RADS分级对良恶性结节的诊断效能。

426个甲状腺微小结节中，良性结节128个，恶性结节298个。良恶性结节位置在左、右侧叶及峡部，横切面腹侧、中部、背侧比较，差异均无统计学意义（P均＞0.05），纵切面上极、中部、下极（良性：23、53、52个；恶性：82、128、88个）和横切面内侧、中部、外侧（良性：47、39、52个；恶性：125、58、115个）比较，差异均有统计学意义（χ²=6.716、6.180，P=0.035、0.045）。Logistic回归分析显示结节位置是预测甲状腺癌的独立危险因素。单纯ACR TI-RADS分级及结节位置联合ACR TI-RADS分级鉴别诊断良恶性甲状腺结节的ROC曲线下面积分别为0.801、0.822，两者曲线下面积比较差异具有统计学意义（Z=2.738，P=0.006）。

甲状腺微小结节位置对其良恶性鉴别具有重要辅助价值。

To assess the value of the location of thyroid micronodules in helping identify their nature.

The location and ultrasonographic features of 426 thyroid micronodules confirmed by pathology at the Second Hospital of Lanzhou University from January 2018 to November 2020 were retrospectively analyzed. Binary logistic regression analysis was applied to identify the independent risk factors for thyroid cancer. Receiver operating characteristic (ROC) curve was drawn to compare the diagnostic efficacy of American College of Radiology thyroid imaging reporting and data system (ACR TI-RADS) alone and nodule location combined with ACR TI-RADS in the diagnosis of benign and malignant nodules.

Of the 426 thyroid micronodules included, 128 were benign and the remaining 298 were malignant. There was no significant difference in the numbers of benign and malignance nodules in the left lobe, right lobe, and isthmus, and in the ventral, middle, and dorsal sides of transverse sections (P＞0.05), while there were statistically significant differences in the upper, middle, and lower poles of longitudinal section (benign nodules: 23, 53, and 52; malignant nodules: 82, 128, and 88; χ²=6.716, P=0.035), and in the medial, middle, and lateral sides of transverse section (benign nodules: 47, 39, and 52; malignant nodules: 125, 58, and 115; χ²=6.180, P=0.045). Logistic regression showed that nodule location was an independent risk factor for thyroid cancer. The areas under the ROC curves of ACR TI-RADS classification alone and nodule location combined with ACR TI-RADS classification for differential diagnosis of benign and malignant thyroid nodules were 0.801 and 0.822, respectively, and there was a significant difference between the two groups (Z=2.738, P=0.006).

The location of thyroid micronodules is of great value in the differential diagnosis of benign and malignant nodules.