二维及彩色多普勒超声对甲状腺乳头状癌的诊断价值

目的 探讨二维及彩色多普勒超声对甲状腺乳头状癌(PTC)的诊断价值.方法 回顾性分析经病理组织学证实的283个PTC和526个甲状腺良性结节的超声表现,对2组结节的各项超声表现的差异进行统计学分析,并分别计算其诊断的敏感性、特异性及准确性.结果 边缘毛糙(敏感性65.3％、特异性91.4％、准确性82.3％)、形态不规则(敏感性61.8％、特异性93.3％、准确性82.3％)、结节纵横比≥1(敏感性65.7％、特异性95.4％、准确性85.0％)、结节内部呈低回声或极低回声(敏感性79.5％、特异性.93.0％、准确性88.3％)、结节内部含微钙化(敏感性69.3％、特异性97.5％、准确性87.6％)、伴颈部淋巴结肿大(敏感性20.1％、特异性96.0％、准确性69.5％)以及结节内部血流信号丰富(敏感性26.1％、特异性93.3％、准确性69.8％)在恶性组中的检出率均较高,与对照组相比差异有统计学意义(P＜0.05).PTC合并正常甲状腺者32例(17.9％),合并甲状腺腺瘤者12例(6.7％),合并结节性甲状腺肿者58例(32.4％),合并桥本甲状腺炎者77例(43.0％),合并桥本甲状腺炎者最多.结论 边缘毛糙、形态不规则,结节纵横比≥1、结节内部呈低回声或极低回声及结节内部含微钙化等指标的诊断准确性较高,是诊断PTC的重要指标,伴颈部淋巴结肿大及结节内部血流信号丰富的敏感性、准确性低但特异性较高,可作为鉴别诊断的参考指标,当桥本甲状腺炎合并可疑结节时更应警惕恶性可能.

Application of two-dimensional and color Doppler ultrasonography in diagnosis of papillary thyroid carcinoma

Objective To investigate the value of two-dimensional and color Doppler ultrasonography in diagnosis of papillary thyroid carcinoma(PTC).Methods The ultrasonic characteristics of 283 PTC and 526 thyroid benign nodules were retrospectively reviewed.All masses were confirmed by pathology.The different ultrasonic characteristics were analyzed statistically.Sensitivity,specificity and accuracy were obtained.Results Statistically significant(P<0.05) findings of PTC were spiculate margin(sensitivity,65.3%;specificity,91.4%;accuracy,82.3%),irregular shape(sensitivity,61.8%;specificity,93.3%;accuracy,82.3%),A/T(anteroposterior/transverse diameter ratio)≥1(sensitivity,65.7%;specificity,95.4%;accuracy,85.0%),low echo-level and marked hypoechogenicity(sensitivity,79.5%;specificity,93.0%;accuracy,88.3%),microcalcifications(sensitivity,69.3%;specificity,97.5%;accuracy,87.6%),enlarged lymph nodes on the neck(sensitivity,20.1%;specificity,96.0%;accuracy,69.5%) and abundant blood flow signals inside the lesions(sensitivity,26.1%;specificity,93.3%;accuracy,69.8%).In the patients with PTC,there were 32 cases(17.9%) complicated with normal thyroid,12 cases(6.7%) complicated with thyroid adenoma,58 cases(32.4%) complicated with nodular goiter,77 cases(43.0%) complicated with Hashimoto’s thyroiditis.Conclusion Presence of spiculate margin,irregular shape,taller than wide,low echo-level and marked hypoechogenicity and microcalcification which have relatively high diagnostic accuracies are important indicators in the discrimination of PTC from benign nodules.For enlarged lymph nodes on the neck,and the abundant blood flow signals inside the lesions,their sensitivities and accuracies are low but specificities are high,which can be used as efficacious reference indication.It must be maintained keen vigilance to cases with suspicious nodule complicated with Hashimoto’s thyroiditis.