摘要
目的比较桥本甲状腺炎(HT)背景下甲状腺良恶性结节的超声影像学特征。方法以2013年1月至12月在北京协和医院经手术病理证实的伴HT良、恶性甲状腺结节连续病例各60例为研究对象,分析比较了其术前超声影像学特征。结果 60例恶性结节中,60例(100.0%)为甲状腺乳头状癌。60例良性结节中,33例(55.0%)为桥本结节样改变,26例(43.3%)为结节性甲状腺肿,1例(1.7%)为腺瘤。与良性结节相比,恶性结节更多表现为实性(91.7%比68.3%,P=0.001)、低回声(96.7%比48.3%,P=0.000)、边界不清(95.0%比41.7%,P=0.000)、形态不规则(96.7%比43.4%,P=0.000)、微钙化(71.7%比30.0%,P=0.000)、缺乏规则晕(96.7%比65.0%,P=0.000)、纵横比≥1(46.7%比13.3%,P=0.000)、血流局部丰富或不规则(61.7%比26.7%,P=0.000)。结论超声对于伴HT的甲状腺结节良恶性鉴别的总体敏感性理想。实性结构、实性成分回声水平低、边界不清晰、形态不规则、缺乏规则晕是较好的筛查指标。除纵横比≥1外,其他指标的诊断特异性均不理想。
Objective To compare the ultrasound imaging characteristics of benign and malignant thyroid nodules on the background of Hashimoto＇ s thyroiditis （HT）.Methods Totally 120 consecutive patients with pathologically confirmed benign （n =60） or malignant （n =60） thyroid nodules in Peking Union Medical College Hospital since January 2013 were retrospectively analyzed,and their preoperative ultrasound images were reviewed.Results Sixty cases （100％） of the malignant nodules were papillary thyroid cancers.In the benign group,33 cases （55.0％） had nodular changes of HT,26 （43.3％） had nodular goiter,and one （16.7％） had adenoma.Compared with the benign ones,the malignant nodules were more likely to be solid （91.7％ vs.68.3％,P=0.001）,hypoechoic （96.7％ vs.48.3％,P=0.000）,ill defined （95.0％ vs.41.7％,P=0.000）,irregular （96.7％ vs.43.4％,P =0.000）,and more easily to have such characteristics as microcalcification （71.7％ vs.30.0％,P =0.000）,absence of regular halo （96.7％ vs.65.0％,P =0.000）,taller-than-wide sign （46.7％ vs.13.3％,P =0.000）,and locally increased or irregular blood flow （61.7％ vs.26.7％,P =0.000）.Conclusions Ultrasound has an ideal overall sensitivity in differentiating nodules on the background of HT.Solid structure,hypo-echogenicity,ill-defined margin,irregular shape,and absence of regular halo are good screening ultrasound markers.Except for the A/T≥ 1,the other variables have less satisfactory diagnostic specificity.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2014年第3期261-266,共6页
Acta Academiae Medicinae Sinicae
基金
国家自然科学基金(81171354)~~
