彩色多普勒超声对甲状腺结节性病变诊断价值的评价

采用ＨＤ１３０００超宽频全数字彩色义检查了９１例甲关腺节性病变的彩色多普勒血流图及多普勒频谱，同时与病变的核素扫描结果对比分析，结果显示结节内Ｒ１〉０．７有助于良恶性的鉴别，其敏感性为７３．７％，特异性为９２．８％，准确性为８９％；峰值流速及血流信号的丰富与否对良恶笥无鉴别意义；血流丰富的凉结节或冷结节我提示腺瘤或初步发现恶性肿瘤血流信号的多少似乎与肿瘤的组织类型有关。     

彩色多普勒超声鉴别甲状腺结节良恶性价值的再探讨

目的：探讨彩色多普勒超声鉴别甲状腺结节良恶性的价值。方法以回顾性分析的方式,选取2013年2月~2014年2月我院收治的甲状腺良性结节患者53例,作为对照组,并选取同期我院收治的甲状腺恶性结节患者57例,作为观察组。对两组患者均进行彩色多普勒超声检查。结果两组患者的混合血管型比例、低血供比例以及高血供比例差异均具有统计学意义(P<0.05)。结论彩色多普勒超声可以在一定程度上鉴别甲状腺结节的良恶性,为临床质量方案的制定提供可靠的参考依据,但准确性却受到较大的限制,还需要进一步加入其它鉴别手段。     

彩色多普勒超声诊断鉴别甲状腺良恶性肿瘤的效果评价

目的 评价彩色多普勒超声诊断鉴别甲状腺良恶性肿瘤的效果。方法 随机选取2016年5月~2017年5月本院收治的甲状腺肿瘤患者60例,所有患者均经手术病理诊断确诊,在此之前均实施彩色多普勒超声诊断鉴别诊断,并与病理结果对比,分析彩色多普勒超声诊断符合率、甲状腺良恶性肿瘤血流分布情况、彩色多普勒超声诊断敏感性度。结果 彩色多普勒超声诊断发现,良性肿瘤37例（61.67%）、恶性肿瘤17例（28.33%）、结节性甲状腺肿3例（5.00%）,其与病理诊断结果相比,差异不具有统计学意义（P＞0.05）;恶性肿瘤血流分布高于良性肿瘤血流分布,差异具有统计学意义（P＜0.05）;彩色多普勒超声诊断敏感度96.67%。结论 彩色多普勒超声在鉴别诊断甲状腺良恶性肿瘤中,诊断效果显著,可为临床诊治提供有效显著,临床应用价值较高,值得推广应用。     

分析彩色多普勒超声诊断甲状腺肿瘤的临床价值

目的研究探讨彩色多普勒超声对于甲状腺肿瘤的临床应用和诊断价值。方法选取我院收治的甲状腺肿瘤患者87例作为研究对象,所有患者均经手术病理证实,回顾性分析患者的临床基本资料和彩超诊断结果。观察患者的彩超诊断图像,分析图像特征。结果经彩色多普勒超声诊断,共检出单侧甲状腺肿瘤69例,其中左侧甲状腺肿瘤和右侧甲状腺肿瘤分别有41例和28例,双侧甲状腺肿瘤18例。超声诊断为甲状腺腺瘤的患者共计59例,其中55例经手术病理证实,超声检测的符合利率为93.2%;诊断为甲状腺癌的患者有11例,但经手术病理证实有甲状腺癌14例,包括8例淋巴结转移的情况,检测的符合率为78.6%;诊断为结节性甲状腺肿的患者17例,经手术病理证实为结节性甲状腺肿的患者有18例,符合率为94.4%。结论彩色多普勒超声可以作为甲状腺肿瘤的辅助诊断措施,具有操作简便、不会对患者造成损伤、诊断符合率高的特点,对甲状腺肿瘤的鉴别具有一定的临床价值。     

乳腺癌彩色多普勒超声的诊断价值

目的探讨超声彩色多普勒对乳腺癌的诊断价值。方法回顾性分析27例经手术、病理证实为乳腺癌的超声表现及彩色多普勒特征。结果二维超声可清晰地显示肿块的数目、形态、大小、边界、内部回声。彩色多普勒可显示肿块内部及周边的血流情况。结论二维超声与彩色多普勒结合对乳腺癌的诊断有较高的诊断价值。     

彩色多普勒超声在子宫颈癌诊断中的价值

目的探讨彩色多普勒超声对子宫颈癌的临床诊疗价值。方法回顾性分析60例宫颈癌的超声检查结果及血流动力学改变。结果早期宫颈癌超声多无阳性发现,随着癌肿的进展,宫颈癌的超声表现有：宫颈体积增大、回声不均匀,宫颈肿块、宫腔积液;宫体、阴道受侵,宫旁浸润,盆腔脏器侵犯,彩色多普勒血流显示宫颈癌病灶可见丰富血流信号。结论彩色多普勒超声诊断宫颈癌的主要价值是观察肿瘤的浸润和转移情况,协助临床分期。指导治疗和观察疗效。     

探讨彩色多普勒超声检查对妇产科急诊的诊断与鉴别诊断价值

目的探讨彩色多普勒超声检查对妇产科急诊的诊断与鉴别诊断价值。方法选取我院2012年6月~2013年6月接收的73例妇产科急诊患者作为观察对象,对患者的临床声像图进行回顾性分析,并进行总结。结果73例妇产科急诊患者经超声诊断结果一致的为71例,符合率为97.26%。50例异位妊娠的患者,经超声检查诊断出48例,10例急性盆腔炎全部检出,8例卵巢囊肿蒂扭转全部检出,5例卵巢囊肿破裂全部检出。结论彩色多普勒超声检查方便简单,诊断准确率高,为临床上对妇产科急腹症的诊断和治疗提供可靠依据。     

多普勒超声对甲状腺肿瘤的诊断价值研究

目的：探讨多普勒超声对甲状腺肿瘤的诊断价值。方法回顾性分析我院68例甲状腺肿瘤诊断检查患者的临床资料,比较患者的多普勒超声声像图特征和病理结果进行比较。结果超声下甲状腺良性肿瘤形态规则,包膜完整,边界清晰,与周围组织无粘连,内部回声均匀,囊壁光滑,肿瘤的后方回声正常,无周围淋巴结侵润和转移。而超声下甲状腺恶性肿瘤的形态不规则,包膜不完整,边界多不清晰,对周边组织有不同程度的浸润,内部回声不均匀,囊壁不光滑,肿瘤的后方回声多衰减,多发钙化灶,可出现颈部及锁骨上淋巴结转移。两组患者周边血流分布比较,差异有统计学意义(=24.19,<0.05)。结论多普勒超声对甲状腺肿瘤具有较好的诊断价值,可以作为疾病初筛的很好诊断手段。     

ThinPrep for cytologic evaluation of follicular thyroid lesions: correlation with histologic findings

Fine needle aspiration (FNA) is often the first step in management of a thyroid nodule. Although papillary carcinomas have distinctive features on conventional smears as well as ThinPrep preparations, cytopathologists rely on the architectural arrangement of cells to classify follicular lesions. The accuracy of ThinPrep in this regard has not been determined. We reviewed all thyroidectomy specimens from a 22-mo period that showed a follicular lesion and had one or more preoperative FNA. The architecture of the lesions on histology was classified as predominantly (>70%) macrofollicular (MA), predominantly microfollicular (MI), mixed (MX), or cystic (C). The presence of colloid, Hürthle cell features, cystic change, Hashimoto's thyroiditis, and nonspecific lymphocytic thyroiditis were also recorded. All FNA specimens were processed with the ThinPrep(R) method and were categorized as nondiagnostic, benign (MA or MX), indeterminate (due to suboptimal cellularity), or suspicious (consistent with a microfollicular or Hürthle cell neoplasm) based on cellularity, architectural arrangement of the follicular cells, and the presence or absence of colloid on FNA. Those cytologic specimens in the indeterminate category were subcategorized as suggestive of an MA, MX, or MI lesion if possible. Histocytologic findings were correlated using Fisher's exact test. A total of 95 patients with 115 FNAs were included in the study (mean age: 48 yr; 75 females and 20 males). Seven of the FNAs were nondiagnostic, 23 benign, 69 indeterminate (5, 8, and 30 favor MA, MX, and MI, respectively, 6 cyst contents and 20 not subclassifiable) and 16 suspicious. The cytohistologic correlation for architecture was significant (P = 0.003). The cytohistologic correlation of cystic change, Hürthle cell change, and the presence of colloid (large fragments of colloid and "tissue-paper-like material" on cytology vs. abundant colloid on histology) was highly significant (P < 0.001, < 0.001, and < 0.03, respectively). In conclusion, thyroid FNA with ThinPrep is useful in predicting the architectural pattern of follicular lesions. It is also reliable in predicting cystic change, Hürthle cell change, and the presence of colloid. Watery colloid is probably present as "tissue-paper-like material" in thyroid FNA ThinPrep preparations.     

Computerized nuclear morphometry in thyroid follicular neoplasms

Differential diagnosis of follicular adenoma (FA) and follicular carcinoma (FC) of the thyroid can be challenging in the routine practice of surgical pathology because the diagnosis of FC is strictly defined and identification depends on the presence of invasion of the capsule or blood vessels. These features may be equivocally presented in the histological sections and interpreted subjectively by different pathologists, so an objective approach to solve this problem is essential. Computerized morphometry is a scientific tool to evaluate cellular changes and it can enhance the interpretation of morphological features by the transformation of pathological changes in cells to a qualitative form. The present study investigated the diagnostic role of objective computerized nuclear morphometry in follicular neoplasms. Thirty-six cases of thyroid FC and 36 cases of FA from patients who were matched by age and sex were studied. Four nuclear parameters were selected and analyzed: mean nuclear area, mean nuclear perimeter, largest to smallest diameter ratio of the nuclei, and coefficient of variation of the nuclear area. The results indicate that all the chosen nuclear variables were significantly correlated with the FA and FC studied. In conclusion, computerized nuclear morphometry can be considered a helpful ancillary tool for differential diagnosis of FA and FC.     

Capsular collagen staining of follicular thyroid neoplasms by picrosirius red: role in differential diagnosis

A key criterion in the diagnosis of thyroid follicular carcinoma is capsular invasion, but invasion cannot always be demonstrated histologically. Since invasion is likely to evoke reactions in the capsular collagen, we examined the effects of invasion on capsular collagen with the picrosirius orange-red (PSR) staining technique for collagen. Under polarized light, the color of PSR-stained collagen varies as a function of the structural and biochemical properties of the collagen fibers. Capsules of widely invasive carcinomas (n = 10), minimally invasive carcinomas (n = 10), and adenomas (n = 28) were stained with the PSR method. Carcinomas were assessed along the thickened capsule for sites of definite invasion, minimal invasion, and no evidence of invasion. In adenomas, sites of thickened capsules (similar to carcinomas) were compared to sites of thin capsules. All foci were evaluated for the color and color intensity of collagen fibers. We found a significantly higher frequency of yellow-green collagen fibers than of orange-red fibers at sites of invasion, whereas orange-red fibers significantly predominated at non-invaded sites. In a minority of cases both colors occurred but the non-dominant color was of lesser intensity in all but 1 case. There were no significant differences in staining between minimally and widely invasive carcinomas. Thick capsules of adenomas consistently stained with an intense orange-red color, although weakly stained yellow-green fibers were also observed in some of these cases. We conclude that PSR staining can provide diagnostically useful information in capsular samples of carcinomas, when both color and color intensity of PSR staining are evaluated at the same site. Specifically, intense yellow-green birefringence of collagen in a thickened capsule is additional evidence for capsular invasion.     

子宫动静脉瘘声像学诊断价值

目的 探讨子宫动静脉瘘彩色多普勒超声及盆腔血管造影的特点.方法 对我院自2005年1月至2008年7月收治的5例子宫动静脉瘘患者的彩色多普勒超声及盆腔血管造影资料进行回顾性分析.结果 子宫动静脉瘘在二维超声图像上无特异性,彩色多普勒血流显示特征性血流信号,多普勒频谱表现为高速低阻特点,盆腔血管造影可显示动静脉瘘形成处血管.结论 彩色多普勒超声及盆腔血管造影是诊断子宫动静脉瘘的可靠方法.     

FNA diagnosis of a metastatic papillary thyroid carcinoma arising from a previously unknown follicular variant of papillary thyroid microcarcinoma

While metastatic tumors to bone or lymph nodes from previously known primaries are often successfully diagnosed via fine‐needle aspiration (FNA), a metastatic deposit in a patient with no previously known cancer may pose a diagnostic dilemma. Here, we present a case of metastatic papillary thyroid carcinoma that presented initially as a large pelvic bone mass. FNA was performed on this mass. The diagnosis was challenging due the fact that the tumor did not display the classic nuclear features associated with papillary thyroid carcinoma, instead the nuclear morphology was in keeping with a follicular thyroid carcinoma. Given the patient's concurrent, unremarkable thyroid imaging studies the final diagnosis required an extensive immunohistochemical work‐up. Diagn. Cytopathol. 2014;42:711–715. © 2013 Wiley Periodicals, Inc.     

Encapsulated papillary thyroid carcinoma, follicular variant: a misnomer

Papillary thyroid carcinoma (PTC) has long been diagnosed based on its unique nuclear features (PTC-N); however, significant observer discrepancies have been reported in the diagnosis of encapsulated follicular patterned lesions (EnFPLs), because the threshold of PTC-N is subjective. An equivocal PTC-N may often occur in non-invasive EnFPLs and benign/malignant disagreements often create serious problems for patients' treatment. This review collects recent publications focusing on the so-called encapsulated follicular variant of papillary thyroid carcinoma (EnFVPTC) and tries to emphasize problems in the histopathological diagnosis of this spectrum of tumors, which covers encapsulated common-type PTC (EncPTC), EnFVPTC, well-differentiated tumor of uncertain malignant potential (WDT-UMP), follicular adenoma (FA) with equivocal PTC-N and minimally invasive follicular carcinoma (mFTC). We propose that EnFVPTC and other EnFPLs with equivocal PTC-N should be classified into a unified category of borderline malignancy, such as well-differentiated tumor of uncertain behavior (WDT-UB), based on their homogeneous excellent outcome. It is suggested that the unified nomenclature of these lesions may be helpful to reduce significant observer disagreements in diagnosis, because complete agreement in the diagnosis of an EncPTC, EnFVPTC or FA by all pathologists may be not possible for this problematic group of tumors. In conclusion, a malignant diagnosis of EnFVPTC should not be used to cover this spectrum of tumors until uncertainty about the nature of this lesion is settled, whether it is benign, precancerous or malignant.