甲状腺结节的超声常见误诊病例分析

目的总结甲状腺结节性病变误诊病例的声像图特征，探讨误诊的原因，提高对此类病变的认识，降低超声检查的误诊率。 方法选取2014年1月至2017年12月期间因超声提示甲状腺恶性肿瘤至上海交通大学附属上海市第六人民医院备行手术治疗的患者资料。所有患者均在我院复行术前甲状腺高频超声检查。选取其中61例超声诊断与病理结果或其他检查结果不符的病例。对这些病例的超声资料及病理等其他检查结果进行分析，对比超声报告中误诊的甲状腺病变类型，总结易混淆的病变在声像图上的差异，探讨诊断、鉴别诊断的思路，并提出适用于日常超声诊断的策略及方法。 结果误诊的病例包括9种病理类型：甲状旁腺病变，食管憩室，甲状腺髓样癌，甲状腺转移癌，颈部恶性肿瘤侵及甲状腺，甲状腺淋巴瘤，甲状腺滤泡癌，甲状腺腺瘤囊性变吸收后改变以及亚急性甲状腺炎。可总结为4种误诊情况：甲状腺乳头状癌（72.1%），甲状腺腺瘤（19.7%），甲状腺未分化癌（3.3%）以及桥本甲状腺炎（4.9%）。针对误诊病例的声像图特征，提出了相应诊断策略，包括实验室检查、超声引导下细针穿刺细胞学检查、同位素扫描等。 结论在常规甲状腺高频超声检查中，不同病变的声像图表现有交叉重叠现象，应当通过结合必要的临床资料、辅助检查手段或配合适当的超声扫查技巧进行鉴别，以减少误诊。

Case analysis of characteristics of thyroid nodules commonly misdiagnosed by ultrasound

ObjectiveTo analysis the characteristics of the thyroid nodules which were inclined to be misdiagnosed as malignancies by ultrasound, so as to raise the awareness and reduce misdiagnosis rate. MethodsA retrospective analysis of a total of 61 cases with highly suspicious thyroid malignancies in sonography, which were consistent with neither final pathological findings nor further examination results, were conducted. Both ultrasonic and pathological results were analyzed and summarized. The strategies and methods to facilitate the ability of differential diagnosis were further discussed. ResultsThe misdiagnosed cases included 9 types: parathyroid lesion, esophageal diverticula, medullary thyroid carcinoma, metastatic thyroid carcinoma, cervical neoplasm with thyroid gland invading, thyroid lymphoma, follicular thyroid carcinoma, absorption of thyroid adenoma with cystic degeneration and subacute thyroiditis. Four types of misdiagnosed cases were summarized: papillary thyroid carcinoma (72.1%), thyroid adenoma (19.7%), anaplastic thyroid carcinoma (3.3%) and Hashimoto′s thyroiditis (4.9%). By combining with laboratory examinations, ultrasound guided fine-needle aspiration cytology examinations, MIBI and other relative examinations, corresponding countermeasures were made. ConclusionEven if the sonograph of thyroid nodules has some typical features of malignancies, it should be further identified by combining the necessary auxiliary examinations or coordinate with scanning skills to reduce the misdiagnosis.