摘要
目的探讨甲状腺微小乳头状癌(PTMC)的高频超声征象的特征表现,以提高PTMC的术前诊断水平。方法回顾性分析2016年7月-2017年7月经手术治疗及病理学证实为甲状腺微小乳头状癌187例患者的高频超声征象的特征,同时选取同期经手术治疗且病理学证实为甲状腺良性病变101例患者作为对照组,比较二组之间高频超声征象特征表现之间的差异。结果恶性组与良性组征象中,在形态是否规则、边界是否清楚、回声强度、钙化有无、纵横比大小及颈部淋巴结是否肿大方面两组间差异均有统计学意义(P均<0.05),而结节个数两组间差异无统计学意义(P=0.322)。PTMC血流以III型血流为主,约占53.7%;良性结节以I型及II型血流为主,约占95.3%。两组血流类型构成差异有统计学意义(P<0.05)。颈部淋巴结转移是PTMC最常见的转移方式,187例PTMC患者中超声发现肿大的淋巴结30例,占16.0%,其中经术后确诊为淋巴结转移的病例数为12例,准确度为40.0%,灵敏度28.6%,特异度89.0%。结论 PTMC的超声图像主要表现为低回声实性结节、形态不规则、边界不清楚、纵横比≥1、结节内部微小钙化、结节内富血流、颈部淋巴结出现异常肿大,出现上述征象时应该高度怀疑结节为恶性。
Objective Through investigating the high frequency ultrasound features of papillary thyroid microcarcinoma(PTMC)to increase the diagnostic standard in PTMC before surgical operation.Methods The characteristics of high frequency ultrasound imaging of 187 patients with PTMC confirmed by surgery and pathology were retrospectively analyzed from July 2016 to July 2017,and 101 cases of thyroid benign nodules in the same period were selected as control. The differences of the characteristics of high frequency ultrasound signs between the two groups were compared. Results In malignant group and benign group,there were significant differences in morphological regularity,clear boundary,echo intensity,calcification,aspect ratio and cervical lymph node enlargement between the two groups(P all <0.05),and no significant difference in the number of nodules(P=0.322). The blood flow of PTMC was mainly type III(53.7%)and benign nodules were mainly type I and type II(95.3%). There was significant difference in blood flow type between the two groups(P<0.05). Cervical lymph node metastasis was the most common way of PTMC metastasis. Among 187 PTMC patients,30(16.0%)had enlarged lymph nodes detected by ultrasonography,and among them,12 cases were diagnosed as lymph node metastasis after operation. The accuracy,sensitivity and specificity were 40.0%,28.6%and 89.0%,respectively. Conclusion The main ultrasonographic features of PTMC are hypoechoic solid nodules,irregular shape,unclear boundary,aspect ratio ≥1,microcalcification in nodules,rich blood flow in nodules,and abnormal enlargement of cervical lymph nodes. When the above signs appear,the nodules should be highly suspected to be malignant.
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