基于超声征象多因素logistic回归β值积分法的甲状腺癌风险预测研究

背景与目的：甲状腺结节的超声征象评分方法已有部分报道,但大多是直接为各征象赋值的方式,鲜有权重评分法的研究。该研究通过筛选超声征象中甲状腺癌的独立危险因素,以基于超声征象多因素logistic回归β值的权重评分法建立甲状腺癌风险预测模型,评估其应用价值并验证其工作效能。方法：选取2015年1月—2018年8月,于华北理工大学附属医院行甲状腺超声检查,并最终取得术后病理学检查结果的结节作为研究对象,1 749例患者的共计1 988个甲状腺结节纳入研究范畴。回顾分析其超声报告、影像及病理学资料,超声征象包括结节的组成成分、回声、形态、边界、纵横比、被膜侵犯、钙化情况,用单因素分析法筛选甲状腺癌的独立危险因素,将其纳入多因素logistic回归方程,以各危险征象的偏回归系数β值为其做权重评分,以结节的总积分建立甲状腺癌风险预测模型,采用受试者工作特征曲线（receiver operating characteristic curve,ROC）评价此模型在实际工作中的应用价值;以2018年9月—2018年12月经病理学检查证实的150例甲状腺结节作为验证数据,绘制ROC评价此模型的工作效能。结果：基于超声征象多因素logistic回归β值积分法的甲状腺癌风险预测模型在鉴别诊断甲状腺结节良恶性ROC下面积为0.953（95% CI：0.942~0.964）,最佳诊断节点为24.2分,诊断的灵敏度、特异度、阳性预测值和阴性预测值分别为88.6%、93.3%、86.8%和94.4%,验证研究的准确率为88.3%。结论：基于超声征象多因素logistic回归β值积分法的甲状腺癌风险预测模型对于鉴别诊断甲状腺结节良恶性具有较高的效能。     

彩色多普勒超声对甲状腺良、恶性结节的鉴别诊断

目的探讨二维及彩色多谱勒对甲状腺良、恶性结节的鉴别诊断价值.方法应用高频率探头二维超声及彩色多普勒超声对121例甲状腺结节患者术前进行检查,全部病例均经手术及病理证实.结果超声能显示病变的数目、大小、位置;不同性质的占位,其CDFI的血流动力学参数具有差异.结论超声对甲状腺结节的诊断和鉴别诊断具有明确的临床应用价值,综合分析甲状腺结节的二维及彩色多普勒超声征象可提高对其鉴别诊断的准确率.     

甲状腺滤泡型乳头状癌的超声特征研究

目的探讨甲状腺滤泡型乳头状癌的超声特征,提高超声诊断的准确率。方法对40例经手术及病理诊断为甲状腺滤泡型乳头状癌的声像图特点进行研究。同时选取同期45例甲状腺良性病变作为对照。结果甲状腺滤泡型乳头状癌的超声表现与甲状腺良性结节对比,其超声表现为实性结节(97.2%)、形态不规则(52.8%)、微小钙化(19.4%)、低回声结节(83.4%)及探及肿大淋巴结(25.0%)。良恶性结节的各征象对比均有统计学差异(P<0.005)。Logistic回归多因素分析显示,回声(OR=3.13,95%CI:1.58~6.19)和微小钙化(OR=2.03,95%CI:1.19~3.48)是诊断甲状腺滤泡型乳头状癌的独立性预测因素。结论甲状腺滤泡型乳头状癌的超声声像图表现存在很大的差异性,只有在充分了解了其超声表现特征的前提下,才能提高其诊断的准确率。     

106例甲状腺微小乳头状癌彩色多普勒超声诊断分析

[目的]总结彩色多普勒超声对甲状腺微小乳头状癌的超声征象,提高术前诊断水平.[方法]分析经手术及病理证实的甲状腺微小乳头状癌106例彩超特征,并选取同期234例甲状腺良性结节作为对照.[结果]甲状腺微小乳头状癌超声征象表现为形态不规则,实性不均质低回声(84.9％)为主,多见微小钙化(58.5％),周边无声晕,以周边及内部血流丰富或紊乱为主,Ⅱ～Ⅲ级血流占55.6％,且动脉峰值流速Vmax和阻力指数RI较良性微小结节显著增加(P＜0.05).[结论]彩色多普勒超声对甲状腺微小乳头状癌早期筛查、术前诊断及鉴别诊断具有重要意义.     

弹性成像在甲状腺单发结节良恶性鉴别诊断中的Logistic回归分析

目的：建立以甲状腺结节超声诊断特征为变量的回归模型,评价常规超声及弹性成像在甲状腺单发结节良恶性鉴别诊断中的价值.方法：对139例患者行常规超声及弹性成像检查,以病理诊断为金标准建立Logistic回归模型.绘制ROC曲线图,评价建立回归模型的预报准确性,比较各变量的似然比,评价弹性成像在甲状腺结节良恶性中的鉴别诊断价值.结果：经过二分类Logistic回归分析,筛选出对甲状腺结节良恶性鉴别诊断中有统计学意义的特征变量包括钙化、CDFI及弹性评分.Logistic回归模型对甲状腺单发结节良恶性预报的正确率为91.40％,敏感性为91.80％,特异性为91.10％.结论：弹性成像较常规超声检查更有助于甲状腺单发结节的良恶性鉴别诊断.     

常规超声联合超声造影鉴别甲状腺结节良恶性的价值

目的 探讨常规超声联合超声造影技术鉴别甲状腺良恶性结节的价值.方法 对62例患者的75个甲状腺低回声结节进行常规超声及超声造影检查,测量结节大小,观察结节形态、边界、位置、有无微小钙化、血流情况及超声造影检查结果.结果 甲状腺结节内部具有多发微小钙化低回声结节13个,形态不规则低回声结节69个,边界不清晰低回声结节69个,结节邻近包膜浸润11个.造影后37个低回声结节呈无增强,38个低回声结节呈低增强,28个低回声结节体积变小.经常规超声检查诊断甲状腺恶性结节65个,经超声造影检查诊断甲状腺恶性结节64个,术后病理证实甲状腺乳头状癌62个,结节性甲状腺肿13个.常规超声联合超声造影诊断甲状腺恶性结节64个,灵敏度为100％,特异度为84.6％,Kappa=0.901.结论 常规超声联合超声造影有助于提高对甲状腺恶性结节的诊断能力.     

超声造影对伴有钙化甲状腺结节的鉴别价值

目的:探讨超声造影对伴有钙化的甲状腺良恶性结节的诊断价值。方法:对287例经手术病理证实的伴有钙化的甲状腺结节进行超声造影检查,应用TomTec软件分析超声造影参数,评估超声造影对伴有钙化甲状腺结节诊断的灵敏性、特异性、阳性预测值和阴性预测值。结果:287个伴有钙化的甲状腺结节中,良性177个,恶性110个。超声造影对伴有钙化的甲状腺结节鉴别诊断的灵敏性、特异性、阳性预测值、阴性预测值分别为93.6%、94.9%、91.9%、96.0%。结论:超声造影对伴有钙化的甲状腺结节有一定的诊断价值。     

甲状腺不典型良性结节超声声像图特征的回顾性分析

目的 探讨甲状腺不典型良性结节的超声声像图特点,以提高鉴别甲状腺良恶性结节的准确性.方法 回顾性分析405例行甲状腺超声检查并行手术切除患者的临床资料,对患者的405个甲状腺结节进行超声检查,并与术后病理结果进行对照研究.结果 经术后病理证实,405个甲状腺结节中,362个为恶性结节,43个为良性结节,超声诊断准确率为89.4％.良性结节中以结节性甲状腺肿为主,结节形态不规则、边界不清晰及结节内点状强回声为其最主要的表现.结论 常规超声辅助其他超声技术有助于提高对甲状腺结节良恶性诊断的准确性.     

甲状腺结节超声诊疗研究进展

甲状腺结节是外科常见病多发病，对甲状腺结节术前诊断多以超声为首选。全文对超声在甲状腺结节诊断中研究进展、引导下介入性检查和治疗作一综述。     

甲状腺结节超声风险分层的利与弊

甲状腺结节风险评估系统在甲状腺结节的临床管理中发挥着重要作用,其分为分级系统和评分系统两大类。甲状腺影像报告与数据分级系统（Thyroid Imaging Reporting and Data System,TI-RADS）作为一种定量分级系统,在21世纪初被首次提出,并不断更新、完善。TI-RADS最大的贡献在于建立了甲状腺结节超声标准化诊断的体系,为临床医师和超声医师搭建了有效沟通的桥梁。就甲状腺结节超声风险分层的发展历史及各版本的优缺点加以总结分析,并讨论TI-RADS在甲状腺结节的个体化、精细化治疗中的发展方向。     

甲状腺微癌47例临床分析

目的：探讨甲状腺微癌的诊治经验和生物学行为。方法：对我院近10年来收治的47例甲状腺微癌进行回顾性分析。结果：女性40例,男性7例,女：男5.7：1。以甲状腺结节就诊的29例,在健康查体中超声发现甲状腺结节18例。发现结节到就诊时间最长15年。手术前47例均行甲状腺彩色超声检查,其中30例提示甲状腺结节内存在钙化呈细砂粒状。术前行甲状腺结节穿刺19例,有8例诊断为甲状腺癌,4例诊断为甲状腺腺瘤,5例诊断为甲状腺肿,2例诊断为桥本氏甲状腺炎。手术行冰冻快速病理诊断43例（包括术前8例）,误诊4例。结论：甲状腺微癌误诊率较高,彩色超声显示甲状腺结节内细砂粒样钙化对甲状腺微癌的诊断有重要的参考价值。对甲状腺微癌的手术治疗应与甲状腺癌一样对待,甲状腺微癌同样有较高的转移率。     

甲状腺结节的术式选择

目的 探讨甲状腺结节的合理手术方式。方法 总结96例甲状腺结节患者行一侧腺叶加峡部切除所采取的术式。结果 96例患者无甲状腺术后并发症。结论 甲状腺一侧腺叶加峡部切除术可作为甲状腺结节的首选术式。     

Primary C-cell hyperplasia within a nodule of thyroid isthmus.

The electron microscopy method was used to study one case of primary C-cell hyperplasia in 'hot' thyroid nodule of isthmus. Hyperplasia of the light form of C cells was found within nodule tissue. It suggests that C-cell hyperplasia within the nodule as well as in normal thyroid tissue plays a role preceding C-cell carcinoma.     

Squamous metaplasia with Hashimoto's thyroiditis presenting as a thyroid nodule

A 59-year-old Japanese female presented a well-limited and movable thyroid nodule. Histologically, the nodule consisted of clusters of squamous cells surrounded by dense connective tissue in Hashimoto's thyroiditis. The squamous cells were well arranged and showed no mitotic figures. We therefore interpreted this nodule as being squamous metaplasia with Hashimoto's thyroiditis rather than squamous carcinoma of the thyroid. There are no previous reports in the literature of nodular formation of squamous metaplasia in the thyroid.     

螺旋CT对甲状腺单发结节良恶性鉴别的价值

目的探讨甲状腺单发良、恶性结节的CT表现。方法通过经病理证实的47例甲状腺单发良性结节和21例恶性结节CT影像对比,分析两者间的CT表现差别。结果47例单发良性结节中39例病变边界清晰、8例病灶边界欠清、26例囊变、10例钙化;21例恶性结节有17例病变边界不清、4例病灶边界较清、8例囊变、9例钙化、6例表现强化残圈征、9例肿瘤侵犯周围组织器官和7例颈部淋巴结转移。结论螺旋CT对甲状腺结节的良、恶性鉴别有重要意义。     

Association of insulin-like growth factor-1 with thyroid nodules

The aim of the present study was to investigate the relationship between insulin-like growth factor-1 (IGF-1) and thyroid nodules. A total of 56 patients with thyroid nodules confirmed by physical examination and ultrasound screening were randomly selected. The patients were divided into three groups by radionuclide scan: the hot nodule group (group 1, n=18); the cold and solid nodule group (group 2, n=18); and the cold and cystic nodule group (group 3, n=20). Cystic fluid samples from patients with cystic cold thyroid nodules were defined as group 4. A control group of 18 healthy adults matched for age, gender and body mass index (group 0) was also included. For all participants, levels of the thyroid hormones, TT3, TT4, TSH and IGF-1, were determined by radioimmunoassay. The measurement data were expressed as the mean ± standard deviation (SD). The analysis of variance was performed by the t-test and the correlation analysis was performed by linear regression. The serum levels of IGF-1 in the solid cold nodule group were significantly higher than those in the hot nodule group (P<0.05). Serum levels of IGF-1 in the cystic cold nodule group were significantly lower than those in the control group (P<0.05). The serum IGF-1 levels in the cystic fluid were significantly lower than those in the cystic cold nodule (P<0.05) and the control groups (P<0.05). Additionally, the mean serum IGF-1 level in patients with thyroid adenoma was significantly higher than that in the control group (P<0.05). The serum IGF-1 level may not be involved in the pathogenesis of hot thyroid nodules and cold and cystic thyroid nodules; however, it may play a significant role in the pathogenesis of certain solid cold thyroid nodules.     

A comparative study of fine needle aspiration cytology, ultrasonography and radionuclide scan in the management of solitary thyroid nodule : A prospective analysis of fifty cases

Solitary thyroid nodule is a common clinical entity encountered by the otorhinolaryngologist and physcians. The optimum diagnostic strategy for the euthyroid patient with a soilitary thyroid nodule is still a matter of debate. The goal of diagnostic workup now is to select those patients for surgery who have a high likelihood of harbouring malignancy in the solitary thyroid nodule. The present study was undertaken to evaluate the utility of FANC in the preoperative diagnosis of solitary thyroid nodule and to evaluate the efficacy of FNAC, VSG and RNS in differentiating between benign and malignant nodules. It was found that FNAC is a safe, reliable and cost effective diagnostic modality with a high sensitivity of 83.3% and specificity of 100% and is the single best investigation for preoperative evaluation of solitary thyroid nodules to differentiate between benign and malignant nodules.     

Intrathyroid parathyroid carcinoma with intrathyroidal metastasis to the contralateral lobe: source of diagnostic and treatment pitfalls

Intrathyroidal parathyroid carcinoma is extremely rare clinical entity with potentially multiple diagnostic pitfalls. We report a case of 40-year-old man presented with classical manifestations of primary hyperparathyroidism, severe hypercalcemia and profoundly increased serum parathyroid hormone level. Neck ultrasonography demonstrated multinodular goiter with predominant 34 mm nodule in left thyroid lobe. Additional 16 mm nodule was found beneath the left lobe. Routine percutaneous fine-needle aspiration of predominant nodule indicated follicular thyroid carcinoma, while left inferior nodule was confirmed to be of parathyroid origin. The patient underwent surgery, during which frozen sections identified medullary thyroid carcinoma with metastasis to upper mediastinal lymph node. Permanent sections of the predominant left lobe nodule revealed intrathyroidal parathyroid carcinoma surrounded with multiple microscopic metastases. Left inferior nodule was metastatic lymph node. Additional 10 mm intrathyroidal metastasis of primary parathyroid carcinoma was found within right thyroid lobe. This case indicates that fine-needle-aspiration and intraoperative biopsy are of limited value in diagnosing parathyroid carcinoma, especially if localized intrathyroidally. Oncological en-block resection is treatment of choice, implying ipsilateral lobectomy in case of thyroid invasion. This firstly described case of intrathyroidal parathyroid carcinoma causing intrathyroidal dissemination may influence future treatment strategies.     

Squamous cell carcinoma of esophagus masquerading as solitary thyroid nodule

Secondary neoplasm of the thyroid mimicking a primary thyroid lesion is a rare finding, especially in an individual without a past history of malignancy. A case of squamous cell carcinoma metastatic to the thyroid (presenting as a solitary thyroid nodule), who had an unsuspected primary in the esophagus is described. Usually, multiple areas of the gland are involved in the secondary involvement of the thyroid. The clinical presentation of an apparently asymptomatic mass with neck lymphadenopathy, normal thyroid functions, and a cold nodule on 99mTcO4- thyroid scan can often lead to a misdiagnosis as primary thyroid neoplasm. The present case underscores the fact that due importance to the subtle signs and symptoms and a high degree of suspicion, whenever the histology is unusual for a thyroid primary, is needed and the workup should include ruling out other primary malignancies.     

Quantitative Analysis of Thyroid Blood Flow and Static Imaging in the Differential Diagnosis of Thyroid Nodules

Objective:To evaluate the performance of combined quantitative analysis of thyroid blood flow and staticimaging data in the differential diagnosis of thyroid nodules. Method: Thyroid blood flow and static imagingwere performed in 165 patients with thyroid nodules. Patients were divided into a benign thyroid nodule group(BTN, n=135) and a malignant thyroid nodule group (MTN, n=30) based on the results of post-surgical pathologicexamination. Carotid artery thyroid transit times (CTTT), perfusion ratio of thyroid nodule blood/thyroidblood (TNB/TB), and perfusion ratio of thyroid nodule blood/carotid artery blood (TNB/CAB) were measuredusing thyroid blood flow imaging. The ratios between thyroid nodule and ipsilateral submandibular gland (TN/SG) and thyroid nodule and normal thyroid tissue (TN/T) were measured from thyroid static imaging. Thedifferences between the BTN and MTN groups were compared. Results: 1) CTTT was markedly lower in theMTN group than the BTN group, the difference being statistically significant. 2) TNB/TB and TNB/CAB wereboth significantly higher in MTN than BTN groups. 3) TN/T was significantly lower in MTN group than BTNgroup. 4) TN/SG was lower in MTN group than BTN group, but the difference was not statistically significant.5) Using the combination of CTTT and TN/T, the sensitivity, specificity and accuracy were 93.1%, 95.3% and94.9% respectively for the diagnosis of MTN. Using the combination of CTTT, TNB/TB and TN/T, the sensitivity,specificity and accuracy changed to 89.7%, 100%, and 98.1% respectively. 6) Correlation analysis demonstrateda significant correlation between TN/T and TNB/TB (r=-0.384, P=0.036) and TNB/CAB (r=-0.466, P=0.009) in theMTN group. Conclusion: The combination of quantitative markers from thyroid blood flow and thyroid staticimaging had high specificity and accuracy in differential diagnosis of benign and malignant thyroid nodules,thus providing an important imaging diagnostic approach.