甲状腺多发结节合并甲状腺癌的超声误诊分析

目的 探讨甲状腺多发结节合并甲状腺癌的超声声像图特征并总结误诊原因,以提高甲状腺癌的超声诊断准确率.方法 回顾性分析40例经手术病理证实为甲状腺癌且超声误诊(或诊断不确定)的甲状腺多发结节的患者的超声图像,观察癌结节的大小、纵横比、形态、边界、包膜、内部回声、钙化特点、周边声晕、血流分布特点、与甲状腺包膜及颈前组织的关系、有无颈部或锁骨上淋巴结的转移、弹性成像表现等与良性结节的超声图像进行对照分析.结果 甲状腺多发结节合并甲状腺癌声像图表现常较为复杂,应逐个结节进行观察分析,癌结节常表现为:(1)形态不规则;(2)纵横比≥1;(3)边界不清;(4)无包膜;(5)内部呈不均质低回声;(6)常见散在分布的簇状微小钙化;(7)周边声晕不完整或缺失;(8)结节内部以中心型供血为主;(9)对甲状腺包膜及颈前组织可有侵犯;(10)个别可探及颈部或锁骨上转移性肿大淋巴结;(11)弹性成像为3~5分.结论 超声对甲状腺多发结节合并甲状腺癌的诊断有一定的客观难度,较易误诊,因此综合分析声像图特征具有重要的临床价值,将有助于提高甲状腺多发结节合并甲状腺癌的诊断准确性.

A Retrospective Analysis of Ultrasonographic Misdiagnosis of Thyroid Multiple Nodules With Thyroid Carcinoma

Objectives To explore the ultrasonic features in the differential diagnosis of thyroid multiple nodules with thyroid carcinoma and summarize the causes of misdiagnosis, and to improve the accuracy of ultrasonic diagnosis of thyroid carcinoma. Methods The ultrasound images from the 40 patients with thyroid carcinoma were selected,whose diagnosis of thyroid carcinoma was confirmed by the pathological examinations after surgery but misdiagnosed or not identified by ultrasound examination. These ultrasound images were retrospectively analyzed through observing the carcinomatous nodules in size,aspect ratio, shape, border, envelope, internal echo,calcification characteristics,posterior echo,acoustic halo, the distribution of blood flow, and the relationship with thyroid capsule and anterior organization,whether to transfer to neck or spraclavicular lymph nodes, and the performance of elasticity imaging, and then these features were compared with the ultrasonic features of the benign thyroid nodules. Results The ultrasonic features of thyroid multiple nodules with thyroid carcinoma were complicated and each nodule should be observed and analyzed individually. The ultrasonic features of carcinomatous nodules were:(1) irregular shape,(2)aspect ratio ≥1,(3)unclear border,(4)no capsule,(5)heterogeneous hypo echo inside of the carcinomatous nodules,(6)scattered distribution of clustered microcalcifications,(7)incomplete acoustic halo or absent,(8)blood supply to the centrality inside of the carcinomatous nodules,(9)invaded thyroid capsule and anterior organizations,(10)transformation to neck or supraclavicular lymph nodes in the minority of patients,(11) elasticity imaging score of 3 ~5. Conclusions It is quite difficult to identify the ultrasonic features of thyroid multiple nodules with thyroid carcinoma and it is with high misdiagnosis rate. A comprehensive analysis of sonographic features is essential in clinical practices, and it will contribute to improving the accuracy of the ultrasonic diagnosis of thyroid multiple nodules with thyroid carcinoma.