目的：回顾性研究Bethesda Ⅴ类甲状腺结节术前诊断甲状腺乳头状癌，探讨Bethesda Ⅴ类和Ⅵ类甲状腺结节之间存在的临床参数差异。方法：分析430例甲状腺病人的临床资料和临床数据。结果：单因素分析Bethesda Ⅴ类结节结果显示，病理检查为恶性组159例与良性组20例在结节边界、肿瘤大小和结节回声差异有统计学意义（P<0.05）。多因素分析显示结节边界、肿瘤大小和结节回声是Bethesda Ⅴ类结节恶性诊断的危险因素。Bethesda Ⅴ类恶性组159例与Bethesda Ⅵ类组251例相比，结节TI-RADS分级、纵横比、回声差异有统计学意义（P<0.05）。进一步的多因素分析结果显示，结节TI-RADS分级、纵横比、结节与包膜的关系、抗甲状腺过氧化物酶抗体含量和结节回声是诊断甲状腺癌的危险因素。结论：在Bethesda Ⅴ类甲状腺结节病人的诊断中，TI-RADS分级越高，其恶性的可能性越大，而TI-RADS分级低的病人需再次充分评估甲状腺结节大小、结节与包膜关系及抗甲状腺过氧化物酶抗体含量。

Objective To study on preoperative diagnosis of papillary thyroid carcinoma (PTC) with Bethesda Ⅴ thyroid nodules retrospectively and to explore the differences of clinical parameters between Bethesda Ⅴ and Ⅵ thyroid nodules. Methods The clinical data of 430 patients were analyzed. Results Univariate analysis showed that there were significant differences of Bethesda Ⅴ nodules in nodule boundary, tumor size and echo between PTC group of 159 cases and benign group of 20 cases (P<0.05). It was shown from multivariate analysis that nodule boundary, tumor size and echo were risk factors for malignant diagnosis of BethesdaⅤnodule. The differences were present significantly in TI-RADS grade, aspect ratio and echo between Bethesda ⅤPTC group of 159 case and Bethesda Ⅵ thyroid nodule group of 251 cases (P<0.05). Further multivariate analysis showed that TI-RADS grade, aspect ratio, relation of nodule with capsule, thyroid peroxidase antibody level and echo were the risk factors for the diagnosis of PTC. Conclusions Bethesda Ⅴ nodules with higher grade of TI-RADS are malignant more possibly and those with lower grade of TI-RADS need to be evaluated such as thyroid nodules sizes, relation of nodules with capsule and thyroid peroxidase antibody level.