超声检查在甲状腺钙化分型的临床意义

目的:探讨超声在甲状腺钙化分型鉴别甲状腺钙化结节良恶性的价值。方法:按照甲状腺钙化大小、形态将钙化结节分成4型:1型,微小点状钙化;2型,斑点斑片状钙化;3型,条形或弧形钙化;4型,囊性结节伴钙化。统计癌性结节与非癌结节出现各类钙化的比例。结果:甲状腺癌结节126个,1型钙化43个(34.1%),2型钙化16个(12.7%),3型钙化6个(4.7%),4型钙化0个,无钙化癌结节61个(48.4%);甲状腺非癌结节540个,其中1型钙化48个(8.8%),2型钙化39个(7.2%),3型钙化44个(8.1%),4型钙化55个(10.1%),无钙化非癌结节354个(65.5%)。癌性结节总钙化发生率51.6%(65/126)大于非癌结节总钙化发生率34.4%(186/540)(P0.05)。1型钙化诊断甲状腺癌敏感性为34.1%,特异性91.2%,阳性预测值47.2%(43/91),1型+2型钙化诊断甲状腺癌的敏感性特异性分别为46.8%和84%,阳性预测值40.4%(59/146)。1型钙化按照超声二维切面最大钙化点数目分类:2个钙化点时,1型钙化诊断甲状腺癌的阳性预测值53.5%(30/56);3个钙化点时阳性预测值80.1%(17/21)。结论:1型钙化诊断甲状腺癌性结节意义最大,且随着二维切面钙化点数目增加其阳性预测值增高,但仍要结合超声其他指标以提高甲状腺癌诊断准确性,3型4型钙化诊断良性结节价值大,其中4型钙化为良性结节的特征性表现。

Clinical value of ultrasounic calcification classification in thyroid nodular

Objective：To discnss the value of ultrasounic calcification classification in diagnosing the benign and malignant thyroid nodules according to the calcification size and morphology.Thyroid calcification was divided into 4 types： type 1,microcalcification;type 2,plaque-calcification;type 3,linear-calcification or arc-calcification,and type 4,calcification in the cystic nodule.The proportion of different types＇ calcification in the benign and malignant was calculated.Results：Among the 126 thyroid malignant nodule,the numbers and proportion of different calcification types and non-calcification type were as fouows： Type 1 with 43（34.1%）,type 2 with 16（12.7%）,type 3 with 6（4.7%）,and type 4 with 0（0%） and non-calcification with 61（48.4%）.Among the 540 thyroid benign nodules,the numbers and proportion of different calcification types and non-calcification type： Type 1 with 48（8.8%）,type 2 with 39（7.2%）,type 3 with 44（8.1%）,type 4 with 55（10.1%） and non-calcification 354（65.5%）.Total proportion of calcification of malignant nodules was 51.6%（65/126）,which was more than that of benign nodules（34.4%,186/540）.The sensitivity,specificity and positive predictive value（PPV） of diagnosing the malignant nodular by Type 1 was separately 34.1%,91.2% and 47.1%,but was separately 46.8%,84.0% and 40.4% by Type 1 plus type 2.According to the max-number of calcification points in the 2-dimensional plane of the nodule,the PPV defining the malignant nodular was 53.5% when max-number was more than 2,but was 80.1% when max-number was more than 3.Conclusion：Type 1 calcification has the highest value of diagnosing the thyroid malignant nodular and have the higher PPV with the increasing of max-number of calcification points in 2-demensional plane,whereas,it has to combine with other manifestations to improve the accuracy of diagnosing the thyroid cancer.Type 3 and 4 calcification have greater value of diagnosing the benign nodule and type 4 is characteristic of benign thyroid nodules.