超声在甲状腺结节处理中的价值:123例甲状腺结节患者超声声像图分析

目的 评估超声在鉴别甲状腺良、恶性结节及制定结节处理方案中的作用.方法对123例甲状腺结节患者的146个结节行甲状腺超声及细针抽吸活检(FNAB),细胞学检查结果为恶性或可疑恶性者接受手术治疗,对超声、FNAB及手术病理进行对比分析.结果在146个结节中,43个结节由组织学诊断为恶性,102个结节主要由临床及细胞学诊断为良性.1个结节细胞学诊断为可疑恶性但失访.甲状腺结节低回声、边界不清、形态不规则、微钙化以及结节内部血流丰富等超声特征多见于恶性结节(P＜0.05).性别、年龄以及甲状腺结节数目、大小在良、恶结节中无明显差别.单独利用各项超声恶性征象筛选行FNAB的恶性甲状腺结节,准确性不足,漏诊恶性率大于25%,在具备上述超声恶性征象中任意一项或两项以上的结节中行FNAB,能够显著减少行FNAB例数,漏诊恶性率小于10%.结论联合各种超声特点,能够初步筛选行FNAB的高危甲状腺癌患者,减少实施FNAB例数,提高成本/效益比.

The value of ultrasound in thyroid nodules management: analysis of ultrasonographic features in 123 patients with thyroid nodules

Objective To evaluate whether ultrasonographic features of thyroid nodules are associated with histological malignancy, and to set up helpful criteria in identifying those who should accept subsequent fine-needle aspiration biopsy (FNAB). Methods 146 thyroid nodules of 123 patients accepted ultrasonographic evaluation and FNAB. All patients but one with suspicious or malignant cytology were operated. Results Out of total 146 nodules, 43 were histologically malignant, 102 were cytologically benign, and 1 nodule with suspicious cytology was not followed. Hypoechoic pattern, blurred margins, irregular shape, microcalcification, and type Ⅲ vascularity were significantly more frequent in malignant than benign nodules (P ＜ 0. 05). No one of the ultrasonographic features could independently predict malignant nodules. A better compromise is probably to apply FNAB in nodules with at least one or two malignant ultrasonographic signs. Conclusion No single parameter could satisfactorily identify a subset of patients to be selectively examined by FNAB. A cost-effective approach to FNAB should depend on combination of specific ultrasonographic features.