误诊为甲状腺癌的甲状腺良性结节的声像图特征与病理表现

目的总结37例甲状腺良性结节超声误诊为甲状腺癌患者的声像图与病理特征。 方法与手术病理镜下诊断结果对照并结合甲状腺超声影像报告数据系统（TI-RADS）评估结果，对37例患者46个甲状腺良性结节术前超声出现的恶性征象特征及超声误诊原因进行分析。 结果仅用灰阶超声误诊的37例患者46个甲状腺良性结节术前超声显示小结节21个，最大径≤10.0 mm，大结节25个，最大径>10.0 mm，其中多数结节具有3个或3个以上恶性征象，表现为实性（89.1%，41/46）、囊实性（10.9%，5/46）、极低回声（87.0%，40/46）、结节边缘不规整（56.5%，26/46）和钙化（76.1%，35/46，微钙化及粗大钙化），部分结节纵横比>1（30.4%，14/46）。以甲状腺超声影像报告与数据系统（TI-RADS）为基础进行评估，46个结节中TI-RADS评估为4c类41个（89.1%，41/46，即具有4个恶性超声征象），TI-RADS 5类5个（10.9%，5/46，即具有5个恶性超声征象），无TI-RAD S 1～3类结节（无恶性超声征象）。46个甲状腺良性结节手术病理显示结节间质广泛纤维化伴玻璃样变及钙化，致超声图像复杂多样，与恶性结节难以鉴别而误诊。 结论甲状腺良性结节间质出现广泛纤维化伴玻璃样变、质硬、出血、钙化、囊性变等病理改变，会使甲状腺结节形态、边界、回声强度、内部结构出现相应改变，低回声或极低回声、边缘规整或不规整、纵横比>1等良恶性征象混合存在或叠加出现时超声易误诊为甲状腺癌。

Analysis of ultrasonographic characteristics of benign thyroid nodules misdiagnosed as thyroid carcinoma: sonography-pathology correlation

ObjectiveTo analyze the ultrasound features of ultrasonograpy-false-positive benign thyroid nodules in 37 cases. MethodsWith pathology results as the golden standard, thirty-seven patients with forty-six nodules were misdiagnosed as thyroid cancer by ultrasonography. The pre-operative diagnosis of ultrasonography were retrospectively reviewed and analyzed. ResultsAmong forty-six thyroid nodules, twenty-one nodules had a diameter of 10.0 mm or smaller, while the other twenty-five nodules had a diameter of larger than 10.0 mm. In all forty-six thyroid nodules, the pre-operative ultrasonography found the majority of nodules with 3 or more than 3 malignant signs. The forty-six thyroid nodules showed solid (89.1%, 41/46), cystic-solid (10.9%, 5/46), marked hypoechogencity (87.0%, 40/46), ill-defined margin (56.5%, 26/46), calcification (76.1%, 35/46), microcalcification and macrocalcification), and taller-than-wide shape (30.4%, 14/46). The thyroid imaging reporting and data system (TI-RADS) lexicon was introduced to describe the lesions: forty-one nodules were categorized as TI-RADS 4c and 5 nodules were categorized as TI-RADS 5. On histology, these misdiagnosed thyroid nodules revealed severe fibrosis, hyalinization and calcification. The ultrasonic images were complicated and difficult to be differentiated from thyroid cancer. ConclusionBenign thyroid nodules with fibrosis, hyalinization, hemorrhage and calcification will lead to the significant change on lesions' morphology, echo intensity and internal structure. When the benign and malignant signs ultrasound co-existed in a single thyroid nodule, benign thyroid nodules might be easily misdiagnosed as thyroid cancer.