Objective: To investigate the feasibility and value of histogram analysis based on two-dimensional gray-scale ultrasonography in the differential diagnosis of medullary thyroid carcinoma (MTC) and thyroid adenoma (TA). Methods: The preoperative ultrasound images of 86 newly diagnosed MTC patients and 100 TA patients treated in the Cancer Hospital of Chinese Academy of Medical Sciences from January 2015 to October 2021 were collected. Histograms were performed based on the regions of interest (ROIs) delineated manually by two radiologists, thereafter, mean, variance, skewness, kurtosis, percentiles (1st, 10th, 50th, 90th, 99th) were generated. The histogram parameters between the MTC group and the TA group were compared, and the independent predictors were screened by multivariate logistic regression analysis. Receiver operating characteristic (ROC) analysis was used to compare the individual diagnostic efficacy and joint diagnostic efficacy of independent predictors. Results: Multivariate regression analysis showed that mean, skewness, kurtosis and 50th percentile were independent factors. The skewness and kurtosis in the MTC group were significantly higher than those in the TA group, and the mean and 50th percentile were significantly lower than those in the TA group. The area under the individual ROC curve of mean, skewness, kurtosis and 50th percentile is 0.654-0.778. The area under the combined ROC curve is 0.826. Conclusion: Histogram analysis based on two-dimensional gray-scale ultrasonography is a promising tool to distinguish MTC from TA, in which the joint diagnosis value of mean, skewness, kurtosis and 50th percentile is the highest.
目的： 探讨基于二维超声灰阶声像图的直方图分析在甲状腺髓样癌(MTC)和甲状腺腺瘤(TA)鉴别诊断中的可行性和价值。 方法： 收集2015年1月至2021年10月中国医学科学院肿瘤医院收治的86例初诊的MTC患者和100例TA患者的术前超声图像。基于超声医师人工勾画的感兴趣区进行直方图分析，计算平均值、方差、偏度、峰度、P(1)、P(10)、P(50)、P(90)和P(99)。对MTC组和TA组之间直方图参数进行比较并用多因素logistic回归分析筛选独立预测因素。用受试者工作特征(ROC)曲线比较独立预测因素的单独诊断效能和联合诊断效能。 结果： 多因素logistic回归分析显示，平均值、偏度、峰度、P(50)是鉴别诊断MTC与TA的独立影响因素(均P<0.05)。MTC组的偏度和峰度(中位数分别为0.67和0.69)明显高于TA组(中位数分别为0.18和0.07)，平均值和(中位数分别为53.01和50.00)P(50)明显低于TA组(中位数分别为73.82和73.50)。平均值、偏度、峰度、P(50)鉴别诊断MTC与TA的ROC曲线下面积为0.654~0.778，平均值、偏度、峰度、P(50)。联合鉴别诊断MTC与TA的ROC曲线下面积为0.826。 结论： 基于二维声像图的直方图分析是鉴别MTC与TA的一个有潜能的工具，其中平均值、偏度、峰度、P(50)的联合诊断价值最高。.
Keywords: Histogram analysis; Medullary thyroid carcinoma; Thyroid adenoma; Ultrasonography.