Sonographic diagnosis of thyroid nodules: correlation with the results of sonographically guided fine-needle aspiration biopsy

PURPOSE: To assess the reliability of sonography in differentiating benign from malignant thyroid nodules and selecting lesions for fine-needle aspiration (FNA). METHODS: During a 2-year period, the following 7 sonographic parameters were assessed in 129 patients with thyroid nodules: size, number, echogenicity, echotexure, margin regularity, presence of calcifications, and presence of a hypoechoic rim. Sonographically guided FNA was performed on thyroid nodules 5 mm in diameter. Out of 184 FNAs, we obtained 168 specimens adequate for cytologic analysis and 16 (9%) nondiagnostic specimens. RESULTS: FNA diagnoses included 150 (89%) benign and 18 (11%) malignant nodules. Among 53 solitary nodules, 11 were carcinomas and 42 were benign (p < 0.01). The mean size of the carcinomas was 28 +/- 12 mm versus 18 +/- 10 mm for benign nodules (p < 0.01). The following sonographic features were significantly associated with malignancy: hypoechogenicity, irregular margins, calcifications, and absence of a hypoechoic rim. Differences in echotexure between malignant and benign nodules were not statistically significant. CONCLUSION: Sonographically guided FNA should be performed on thyroid nodules 5 mm in diameter with sonographic characteristics that suggest malignancy.     

Value of Contrast-Enhanced Ultrasound in Differentiating Clinically Atypical Subacute Thyroiditis from Papillary Thyroid Carcinomas

Our objective was to provide the various sonographic characteristics of clinically atypical subacute thyroiditis (CAST) in distinguishing CAST from papillary thyroid carcinomas (PTCs) by using conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). Forty-six CAST patients and 50 PTC patients were enrolled in this study. We evaluated the size, shape, margin, echogenicity, calcification, vascularity and CEUS parameters for each nodule. The final diagnosis of CAST was confirmed via fine-needle aspiration (FNA) or surgery. Of the 46 CASTs, 13 (28.3%) were confirmed by surgery to be benign, and 33 (71.7%) were proven by FNA to be benign. Univariate analysis indicated that compared with PTCs, CAST lesions more frequently had wider-than-taller shapes, blurred margins, the absence of microcalcifications, peripheral high echogenicity, the absence of internal vascularity, hypo-enhancement, centrifugal perfusion and a peak intensity index <1 and area under the curve index <1 on pre-operative US and CEUS. A multivariate analysis revealed that clear margins, microcalcifications and centripetal perfusion were independent characteristics related to PTCs for their differentiation from CAST (all p values <0.05). Our study indicated that the pre-operative multiparameter US characteristics may serve as a useful tool for distinguishing CAST from malignant thyroid nodules to avoid surgical excisions or unnecessary FNAs.     

美国甲状腺协会超声分类与细针穿刺细胞学检查诊断良恶性甲状腺结节

目的 评价美国甲状腺协会（ATA）超声分类与甲状腺细针穿刺（FNA）细胞学检查对良恶性甲状腺结节的诊断价值。方法 回顾性分析342例甲状腺结节患者（共357个结节）的资料。所有患者均于超声检查后接受外科手术或FNA细胞学检查。根据2015年版ATA甲状腺结节诊治指南,对超声图像进行分类评估,并与术后病理结果对照,评价ATA超声分类及FNA细胞学检查的诊断效能。结果 357个甲状腺结节中,248个经术后病理确诊,包括233个恶性结节及15个良性结节。对照病理结果,超声ATA分类诊断甲状腺恶性结节的准确率为88.31%（219/248）,敏感度为90.99%（212/233）,特异度为46.67%（7/15）,阳性预测值为96.36%（212/220）,阴性预测值为25.00%（7/28）;FNA细胞学检查诊断甲状腺恶性结节的准确率为98.81%（83/84）,敏感度为100%（75/75）,特异度为88.89%（8/9）,阳性预测值为98.68%（75/76）,阴性预测率为100%（8/8）。ROC曲线分析显示,2种方法诊断恶性甲状腺结节的曲线下面积（AUC）分别为0.653和0.944（Z=2.397,P=0.017）。结论 ATA超声分类方法对鉴别良恶性甲状腺结节具有较高的诊断价值,FNA细胞学检查能更加有效地判断甲状腺结节性质。     

三维容积成像在甲状腺实性结节诊断中的应用

目的 探讨三维容积成像在甲状腺实性结节良恶性鉴别中的应用价值。方法 对119例甲状腺实性结节手术患者共144个结节行二维及三维超声检查,利用三维容积及断层技术行三维重建,分析良恶性结节的冠状面成像特征,评价其诊断价值。结果 144个结节中,良性结节75例,恶性结节69例。冠状面成像特征中,良恶性结节的形态、边界、边缘有无成角或毛刺、内部回声及有无微钙化差异均有统计学意义(P均<0.05)。建立Logistic回归模型,最终进入模型的甲状腺恶性结节冠状面成像特征包括形态不规则、边缘成角或毛刺、低回声。三维超声诊断甲状腺恶性实性结节的敏感度为92.75%(64/69),特异度为85.33%(64/75),准确率为88.89%(128/144),均高于二维超声[89.86%(62/69),80.00%(60/75),84.72%(122/144)],但两者的诊断效能差异均无统计学意义(P均>0.05)。结论 在三维冠状面成像中,甲状腺良恶性结节的特征差异显著。三维容积成像在甲状腺实性结节的良恶性鉴别诊断中具有重要的价值。     

超声检查甲状腺结节钙化类型与甲状腺癌的关系分析

目的 探讨甲状腺结节钙化类型对结节良恶性鉴别诊断的意义.方法 回顾性分析522例患者576个甲状腺结节的术前二维及彩色多普勒超声检查和术后病理结果.结果 甲状腺良性结节钙化发生率低于恶性结节钙化发生率(P＜0.001).恶性结节I型钙化发生率高于良性结节(P＜0.001).I型微钙化诊断恶性结节的敏感性60%,特异性88%,准确率82%,比值比(OR)为11.28.Ⅳ型钙化均见于良性结节.Ⅱ、Ⅲ型钙化发生率在良恶性结节中差异无统计学意义.年龄＜45岁的患者结节钙化时患甲状腺癌的OR为11.33.单发结节钙化时患甲状腺癌的OR为20.48.结论 甲状腺结节钙化与甲状腺癌有关,特别是结节内出现I型微钙化、患者年龄＜45岁和单发结节出现钙化时,其患甲状腺癌的危险性明显增加.     

不同类型甲状腺钙化结节超声病理相关性研究

目的探讨钙化灶在甲状腺结节良恶性诊断中的意义。方法回顾性分析1 344例行粗针穿刺的甲状腺结节,将其按有无钙化及不同钙化类型进行归类,分为无钙化、簇状微钙化、小钙化、粗大钙化及环状钙化组。统计其与结节良恶性的关系。结果 1 344例结节中,良性972例,恶性372例;有钙化744例,无钙化600例。恶性结节钙化发生率(66.13%)、簇状微钙化发生率(72.22%)及小钙化发生率(41.94%)均高于良性结节(P0.01)。钙化诊断甲状腺结节良恶性的特异度和灵敏度分别为66.13%和48.77%,阳性预测值及阴性预测值分别为33.06%及79.00%。簇状微钙化特异度更高,其特异度为97.94%,灵敏度为13.98%,阳性预测值及阴性预测值分别为72.22%及74.84%。结论簇状分布的微钙化诊断甲状腺恶性结节的特异性高,可以作为诊断甲状腺恶性肿瘤的特征性表现。完整的环状钙化则多为甲状腺良性肿瘤的表现。小钙化和粗大钙化不能单独应用于甲状腺良恶性肿瘤的诊断,必须结合其他超声特征综合判断。     

Relationship Between Morphologic Characteristics of Ultrasonic Calcification in Thyroid Nodules and Thyroid Carcinoma

The aim of this study was to investigate the relationship between morphologic characteristics of the calcifications detected by ultrasound in thyroid nodules and thyroid carcinoma. Morphologic characteristics of the calcifications on pre-operative ultrasound examinations of thyroids were compared with post-operative pathologic diagnoses in 543 patients undergoing thyroid surgery. Calcifications were divided into microcalcifications (≤2 mm) and macrocalcifications (>2 mm), and the latter were divided into eggshell calcifications in a row, eggshell discontinuous calcifications, irregular calcifications and multilayer-like calcifications, labeled types I–V. We found that thyroid microcalcifications and partial macrocalcifications, such as eggshell discontinuous calcifications, and multilayer-like calcifications were associated with thyroid carcinoma. In conclusion, microcalcifications were more commonly found in malignant thyroid nodules, particularly in papillary thyroid carcinoma. Eggshell discontinuous macrocalcifications and multilayer-like macrocalcifications also occurred mainly in malignant nodules.     

Sonographic Differentiation of Thyroid Nodules With Eggshell Calcifications

Objective. The purpose of this study was to assess the role of known suspicious sonographic findings and to find other additional sonographic findings to differentiate benign and malignant thyroid nodules with “eggshell” calcifications. Methods. Our Institutional Review Board approved this retrospective study, and informed consent was not required. We reviewed sonographic findings of thyroid nodules in 795 patients who underwent thyroid surgery in our institution between August 2006 and February 2007. Ninety‐three thyroid nodules with eggshell calcifications in 92 patients were included in this study. Each lesion was evaluated for known suspicious sonographic criteria, including marked hypoechogenicity, irregular or microlobulated margins, and a taller‐than‐wide shape, as well as 2 additional sonographic findings: a hypoechoic halo and disruption of eggshell calcifications (halo and disrupted calcification rim). The sensitivity and specificity based on the sonographic criteria were calculated and compared among the 2 types of criteria. Results. Among the 93 thyroid nodules, 59 were malignant and 34 were benign. The halo and disrupted calcification rim showed higher sensitivity (62.7% and 76.3%, respectively) than any of the known suspicious sonographic criteria (40.7%, 35.6%, and 55.9%). The combination of both the halo and the disrupted calcification rim showed significantly higher sensitivity (93.2%) than the combination of the known suspicious sonographic criteria (78%; P < .05), although both had the same specificity (64.7%). Conclusions. In thyroid nodules with eggshell calcifications but no other calcifications, the findings of a peripheral halo and disruption of the eggshell calcifications may be more useful sonographic predictors of malignancy than hypoechogenicity, microlobulated margins, and a taller‐than‐wide shape.     

Thyroid nodules: Re-evaluation with ultrasound

The purpose of this study was to clarify ultrasound (US) evaluation of microcalcifications and determine whether the calcifications seen in US scans can reliably predict malignant thyroid tumors. Diagnostic accuracy of microcalcification and other various signs seen in US scans for predicting malignancy was evaluated prospectively in 259 pathologically verified thyroid nodules. Sonographic and pathologic correlation of calcifications was performed on 69 of 99 surgically removed nodules. Pathologic studies revealed that hyperechoic areas with acoustic shadowing represented mostly amorphous dense calcifications and sometimes microcalcifications, but small particles without acoustic shadowing mainly reflected microcalcifications and sometimes large amount of fibrous bands and condensed colloids. of the various sono-graphic signs, microcalcification showed the highest accuracy (76%), specificity (93%), and positive predictive value (70%) for malignancy as a single sonographie sign, but its sensitivity (36%) was poor. Although sonographic microcalcification showed relatively high specificity, the accuracy of this finding for malignancy was insufficient. © 1995 John Wiley & Sons, Inc.     

Sonographic Features of the Follicular Variant of Papillary Thyroid Carcinoma

Objective. The purpose of this study was to evaluate the sonographic findings of the follicular variant of papillary thyroid carcinoma (FVPTC) and to assess the role of preoperative fine‐needle aspiration biopsy (FNAB). Methods. The sonographic findings of 27 thyroid nodules in 26 patients (2 male and 24 female; mean age, 45 years) with surgically proven FVPTC were reviewed retrospectively. Findings were categorized according to the echogenicity, margin, shape, and presence of microcalcifications. Malignant findings included marked hypoechogenicity, irregular or microlobulated margins, a taller‐than‐wide shape, and microcalcifications. Thyroid nodules with a single malignant finding as described above were classified as malignant. All patients underwent sonographically guided FNAB, and the sensitivity of the cytologic results was calculated. Results. Lesion sizes varied from 3 to 34 mm (mean, 15.2 mm), and lesions were most commonly solid (23 [85.2%]), hypoechoic (14 [51.9%]), and oval (17 [63%]) with well‐defined margins (14 [51.9%]) and no microcalcifications (23 [85.2%]). Eighteen lesions (66.7%) were correctly classified as malignant, whereas 9 (33.3%) were classified as benign on the basis of sonographic criteria. Twenty‐four samples were adequate for cytologic examination, and 3 were inadequate. Twenty‐one of 24 diagnostic cytologic results (87.5%) were suspicious for papillary carcinoma (5 of 21 [20.8%]) or malignant (16 of 21 [66.7%]), whereas 3 lesions (12.5%) had benign results. The sensitivity of FNAB was 77.8% (21 of 27). Conclusions. The follicular variant of papillary thyroid carcinoma tends to have relatively benign sonographic features, such as hypoechogenicity, well‐defined margins, an oval shape, and no microcalcifications, but most lesions were correctly classified as malignant by both sonography and FNAB. The possibility of FVPTC should be considered when thyroid nodules with a relatively benign sonographic appearance have suspicious or malignant FNAB results     

A New Marker for Diagnosis of Thyroid Papillary Cancer

Objective. The purpose of this study was to correlate the presence and patterns of distribution of B‐flow imaging (BFI) twinkling signs within thyroid nodules with the histologic evidence of microcalcifications and the results of the sonographically guided fine‐needle aspiration to establish their role in predicting the risk of malignancy. Methods. Between September 2006 and December 2007, 343 consecutive patients with 479 suspected nodules (maximum diameter >9 mm) were enrolled in this prospective study. Sonographic and BFI examinations were performed with a commercially available real‐time sonography system, and all patients also underwent a cytologic evaluation. Written informed consent was obtained from all patients. Patients with suspicious or malignant cytologic features underwent surgery. Results. On histologic examination, 66 of 479 nodules were malignant (59 papillary thyroid carcinoma, 1 Hürthle cell carcinoma, and 6 follicular carcinoma). All sonographic characteristics, which were potential predictors of thyroid malignancy (microcalcifications, hypoechogenicity, absence of a halo, and a predominantly solid composition), were found in different percentages in both histologically verified malignant and benign nodules. For BFI, pattern 3 (≥ 4 signs and distance >2 mm) was the most predictive factor for malignancy (specificity, 99.6%; sensitivity, 65.2%), whereas pattern 2 (≥ 4 signs and distance <2 mm) was a positive factor because it was detected only in benign lesions, with a positive predictive of 0. Conclusions. Our results indicate that BFI can overcome the limits of the traditional B‐mode and color Doppler sonographic features in the diagnosis of thyroid nodules. This technique provides maximum specificity levels both in the case of benign nodules with pattern 2 and in the case of malignant nodules with pattern 3.     

常规超声特征联合内部粗大钙化特征鉴别甲状腺结节良恶性的价值

目的探讨常规甲状腺结节声像图特征联合内部粗大钙化特征鉴别结节良恶性的价值。 方法回顾性分析2018年1月至2020年7月于常州市第一人民医院就诊并经病理证实的217例患者共229个甲状腺结节的超声图像。纳入结节的超声声像图均提示结节内存在粗大钙化。以病理结果为金标准,将甲状腺结节分为良性组（n=110）和恶性组（n=119）。单因素分析比较2组结节的常规超声声像图特征以及内部粗大钙化特征的差异,其中常规结节特征包括最大径、纵横比、回声强度、生长方式、成分、边缘和彩色多普勒血流信息,内部粗大钙化特征包括厚度、钙化连续性中断（简称“中断”）、形态、钙化外软组织边缘、钙化回声均匀性和位置。采用二元Logistic回归分析建立常规结节特征、常规结节特征与内部粗大钙化特征相结合的联合预测模型（模型1、模型2）。采用ROC曲线和Z检验分析比较各参数及联合预测模型的诊断效能。 结果恶性组甲状腺结节的最大径≤1.25 cm、纵横比＞0.78、实性成分、垂直位生长、边缘不规则或腺外侵犯以及内部粗大钙化厚度不规则、中断、回声高低不一、存在软组织边缘、中央型钙化均较良性组多见,且差异均具有统计学意义（P均＜0.05）。模型1纳入结节最大径、纵横比和边缘,模型2纳入结节最大径、纵横比、钙化厚度、连续性中断和钙化位置。模型2的敏感度、特异度、阳性预测值、阴性预测值和准确性分别为81.85%、82.73%、82.29%、80.18%和81.22%,其ROC曲线下面积高于模型1（0.877 vs 0.753,Z=4.197,P＜0.001）。 结论结节内粗大钙化厚度不规则、连续性中断、中央型钙化等声像图特征有助于结节良恶性的诊断。在观察结节常规声像图特征的同时,联合评估内部粗大钙化的特征对鉴别甲状腺结节的良恶性有重要意义。     

基于机器学习M超测量甲状腺结节FNAC过程位移对其良恶性的诊断价值

摘 要 目的 应用机器学习方法评价M型超声在超声引导下甲状腺结节细针穿刺细胞学检查(US-G FNAC)过程中结节平均位移距离与其良、恶性之间关系,评价其鉴别结节病理性质的价值。方法：收集整理病理明确诊断的甲状腺结节145例,其中恶性结节84例,良性结节61例。上述患者均行超声引导下结节细针穿刺,操作过程中进行动态存图。所有图像均使用Free-Xros M后处理,测量穿刺频率及其位移大小,用支持向量机（SVM）来分析平均结节位移距离与其良、恶性的关系。结果：甲状腺FNA结节大小、形态、位置、血流以及FNA穿刺频率等在良恶性结节中差异均无明显统计学意义（P均＞0.05）。而FNA穿刺过程中结节平均位移在诊断结节良恶性有很好的价值,其敏感性为85.96%,特异性为85.57%,阳性预测值为79.03%,阴性预测值为90.24%,准确性为85.51%, ROC曲线下面积0.855;结论：M超在超声引导下甲状腺结节FNA的平均位移是一个辅助诊断结节良恶性指标,有望作为病理学不明确结节的有效定性指标。     

甲状腺微小癌的超声征象及其诊断价值

目的 评价灰阶超声在甲状腺微小癌中的诊断价值.方法 回顾性分析58个甲状腺微小癌灶(恶性组)的灰阶超声表现,包括结节的大小、回声水平、内部成分、形态、纵横比、边界、周边声晕、钙化类型,并与61个≤1 cm的甲状腺良性结节(良性组)灰阶超声表现相比较.两组间差别的统计学处理采用X2检验.计算各项超声征象的敏感性、特异性、阳性预测值、阴性预测值和准确性.结果 恶性组中,48.3%为极低回声,98.3%为实性结节,74.1%形态不规整,72.4%纵横比≥1,37.9%有周边不规则声晕,62.1%内含微小钙化.上述超声征象恶性组的显示率明显高于良性组(P＜0.001),而边界不清在两组间的显示率差异无统计学意义.使用极低回声、纵横比≥1、微小钙化三项特异性较高的超声征象作为联合诊断指标,敏感性为86.2%,特异性为77.0%,准确率为81.5%.结论 甲状腺良恶性结节(≤1 cm)的灰阶超声表现有一定差异,综合运用各超声征象对甲状腺微小癌的诊断及鉴别诊断具有较大的临床应用价值.     

Cystic Thyroid Nodules After Aspiration Mimicking Malignancy

Objective. The purpose of our study was to provide sonographic findings of cystic nodules, which can mimic malignancies, after fine‐needle aspiration (FNA) and to determine the differential points from malignancies. Methods. We retrospectively reviewed the sonographic findings of 33 lesions in 32 patients who had FNA for predominantly cystic nodules or cysts and showed suspicious findings during sonographic follow‐up, as well as findings of 47 surgically confirmed papillary thyroid carcinomas (PTCs) in 45 consecutive patients. We evaluated the size, shape, presence of shadowing and a halo, margin, echogenicity, and presence of echogenic dots for each nodule. The final diagnosis of cystic nodules was confirmed by FNA, surgery, or follow‐up sonography. Results. Of the 33 cystic lesions, 31 (94%) were adequate with benign results, and 2 (6%) were inadequate specimens at the initial FNA. There were no malignancies in the cystic nodules at follow‐up. The average interval between the initial FNA and suspicious sonographic findings was 26 months (range, 1–92 months). The average size of the suspicious nodules was 0.8 cm (range, 0.3–1.8 cm). Cystic nodules after aspiration were similar to PTCs in their sonographic findings, but the former frequently showed shadowing and a halo (85% versus 21%; P < .0001). With further follow‐up, 29 lesions (88%) showed additional decreases in size. Conclusions. Benign cystic nodules after aspiration can have suspicious malignant features. However, shadowing and a halo associated with malignant features are characteristic findings of cystic nodule shrinkage. Awareness of these findings and correlation with the FNA history can aid in preventing unnecessary FNA.     

Computerized Quantification of Ultrasonic Heterogeneity in Thyroid Nodules

To test whether computerized quantification of ultrasonic heterogeneity can be of help in the diagnosis of thyroid malignancy, we evaluated ultrasonic heterogeneity with an objective and quantitative computerized method in a prospective setting. A total of 400 nodules including 271 benign thyroid nodules and 129 malignant thyroid nodules were evaluated. Patient clinical data were collected, and the grading of heterogeneity on conventional gray-scale ultrasound images was retrospectively reviewed by a thyroid specialist. Quantification of ultrasonic heterogeneity (heterogeneity index, HI) was performed by a proprietary program implemented with methods proposed in this article. HI values differed significantly between benign and malignant nodules, diagnosed by a combination of fine-needle aspiration and surgical pathology results (p < 0.001, area under the curve = 0.714). The ultrasonic heterogeneity of these samples, as assessed by an experienced clinician, could not significantly differentiate between benign and malignant thyroid nodules. However, nodules with marked ultrasonic heterogeneity had higher HI values than nodules with homogeneous nodules. These results indicate that the new computer-aided diagnosis method for evaluation of the ultrasonic heterogeneity of thyroid nodules is an objective and quantitative method that is correlated with conventional ultrasonic heterogeneity assessment, but can better aid in the diagnosis of thyroid malignancy.     

微血管成像联合FNA在甲状腺良恶性结节中的应用

目的探讨微血管成像(SMI)联合细针穿刺(FNA)检查在甲状腺结节良恶性诊断中的临床应用价值。方法选取215例甲状腺结节患者,术前均做SMI、FNA检查。基于SMI、FNA及二者联合对诊断甲状腺结节良恶性的真实性、可靠性和收益评价,建立ROC曲线评价系统并计算ROC曲线下面积(AUC)。结果 SMI与FNA的灵敏度、特异度及准确率差异无统计学意义,P>0.05;SMI和FNA联合诊断的灵敏度、特异度、准确率为91.2%、92.4%、92.0%、约登指数为0.76、ROC曲线下面积为0.91,高于各单项检查。结论微血管成像结合FNA能够提高超声对甲状腺良恶性结节的诊断效能。     

甲状腺单发结节的超声诊断

目的探讨超声对甲状腺单发结节的诊断价值。方法回顾性分析173例经手术病理证实的甲状腺单发结节,将其术前超声结果与术后病理作比较,并分析相应声像图特点。结果本组中超声对良性结节的诊断符合率为93．7％,对恶性结节的诊断符合率为607％。有5例未提示良恶性,占2．9％。良性结节中,超声对甲状腺腺瘤的诊断符合率为607％（34／56）,腺瘤外其他良性结节病变,28．4％（21／74）误诊为恶性结节,2．7％（2／74）误诊为甲状腺腺瘤,4．1％（3／74）性质待定（不确定良恶性）。良恶性结节声像图在纵／横比、内部及后方回声、包膜、钙化、颈部淋巴结等方面差异均有统计学意义（p〈0．05）,而在结节的边界、内部血流以及血流阻力指数（RI）等方面差异无统计学意义（P〉0．05）。结论超声对甲状腺单发结节性病变有较高的诊断价值。     

超声诊断伴周边环形钙化甲状腺结节良恶性的价值

目的 探讨超声对伴周边环形钙化良恶性甲状腺结节的鉴别诊断价值。方法 回顾分析经手术病理确诊的73例伴周边环形钙化甲状腺结节的超声声像图特征,分析良恶性甲状腺结节的声像图特点,并进行统计学分析。计算各声像图特征对伴周边环形钙化良恶性甲状腺结节的鉴别诊断效能。结果 73例患者中,良性甲状腺结节58例（58/73,79.45%）,恶性甲状腺结节15例（15/73,20.55%）。良、恶性结节的平均最大径、边界和内部回声、钙化周围有无声晕差异均无统计学意义（P均>0.05）。良恶性结节伴结节性甲状腺肿的构成比差异、钙化厚薄是否均匀和钙化的连续性差异有统计学意义（P均<0.05）。以伴结节性甲状腺肿诊断良性甲状腺结节的敏感度、特异度、阳性预测值、阴性预测值分别为77.59%（45/58）、60.00%（9/15）、88.24%（45/51）、40.91%（9/22）;钙化厚薄不均诊断恶性甲状腺结节的敏感度、特异度、阳性预测值、阴性预测值分别为53.33%（8/15）、87.93%（51/58）、53.33%（8/15）、87.93%（51/58）。钙化连续中断诊断恶性甲状腺结节的敏感度、特异度、阳性预测值、阴性预测值分别为73.33%（11/15）、68.97%（40/58）、37.93%（11/29）、90.91%（40/44）。结论 超声对于伴环形钙化甲状腺结节良恶性判断有一定的价值,钙化厚薄不均、连续性中断对诊断恶性病变价值更高。     

Differentiation of Thyroid Nodules With Macrocalcifications

Objective. The purpose of this study was to determine which types of macrocalcifications are associated with thyroid carcinoma and to assess the role of other suspicious sonographic findings in thyroid nodules with macrocalcifications. Methods. Our Institutional Review Board approved this retrospective study, and informed consent was not required. We reviewed sonographic findings of thyroid nodules in 722 patients that underwent thyroid surgery in our institution between March 2006 and August 2006. Sonographic results were grouped into 3 types of macrocalcifications. Each lesion was evaluated on the basis of other suspicious sonographic criteria, including marked hypoechogenicity, irregular or microlobulated margins, and a taller‐than‐wide shape. Sensitivity and specificity based on sonographic criteria were calculated and compared among the subtypes of macrocalcifications. Results. One hundred seventy‐four nodules showed macrocalcifications; 116 were malignant, and 58 were benign. Among the macrocalcification categories, solitary calcifications were more common in benign thyroid lesions, whereas coarse calcifications not otherwise specified were more common in malignant lesions (P < .05). Although the risk of malignancy was 17.2% in cases with no suspicious sonographic findings, the risk of malignancy was up to 82.8% in cases with at least 1 of the sonographic criteria (P < .05). On the basis of the suspicious sonographic criteria, the overall sensitivity was 82.8%. There was no statistically significant difference in sensitivity among the macrocalcification subtypes (P > .05). Conclusions. Suspicious sonographic features such as marked hypoechogenicity, irregular or microlobulated margins, and a taller‐than‐wide shape can play important roles in differentiating benign and malignant thyroid nodules with macrocalcifications.