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.

Thyoid calcifications patterns in sonography and its association with thyroid carcinoma

Objective To evaluate the significance of sonographically detected thyroid calcification in the diagnosis of thyroid carcinoma.Methods Five hundred and twenty-two patients with thyroid disease,including 119 with thyroid cancer,were included in the study.Each patient underwent preoperative,highresolution sonography to evaluate the thyroid gland for the presence of calcification.Calcifications were classified:type Ⅰ,microcalcification;type Ⅱ,coarse calcification;type Ⅲ,annular or"egg-shell"calcification;typeⅣ,calcified nodules within a cyst.Results The incidence of calcification and microcalcification was significantly higher in thyroid cancer than in benign nodules(P＜0.001).The appearance of microcalcifications was highly specific for malignancy with a sonographic specificity of 88%.The sensitivity was 60%,and the odds ratio(0R)was 11.28.The incidence of calcifications of type Ⅱ and type Ⅲ did not differ significantly between the benign and malignant groups.Calcifications of type Ⅳ were showed totally in benign groups.Patients younger than 45 years with calcified nodules constituted a highrisk group,with a OR of 11.33 versus 2.96 in patients older than 45 years with calcified nodules.In the group of solitary thyroid nodules,the incidence of cancer in the calcified nodules was higher than in the nodules without calcifications,with a OR of 20.48.Conclusions The detection of thyroid calcifications by sonography is diagnostically valuable,especially in eases involving a solitary nodule or a young person.The presence of calcifications in these cases should raise the suspicion of malignancy,especially microcalcification.