超声诊断儿童甲状腺良恶性结节
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摘要
目的探讨超声鉴别诊断儿童甲状腺结节良恶性的价值。方法回顾性分析经病理证实的120例甲状腺结节患儿的超声表现,比较良恶性甲状腺结节间超声特征的差异。结果 120例中,甲状腺恶性结节71例(71/120,59.17%),良性结节49例(49/120,40.83%)。良恶性甲状腺结节的超声形态、边界、边缘、内部结构、回声、钙化类型差异均有统计学意义(P均<0.05);上述超声特征诊断恶性甲状腺结节的准确率分别为80.00%(112/140)、78.57%(110/140)、78.57%(110/140)、81.43%(114/140)、82.86%(116/140)、87.86%(123/140),敏感度为68.29%(56/82)、70.73%(58/82)、73.17%(60/82)、97.56%(80/82)、90.24%(74/82)、79.27%(65/82),特异度为96.55%(56/58)、89.66%(52/58)、86.21%(50/58)、58.62%(34/58)、72.41%(42/58)、100%(58/58)。71例恶性甲状腺结节中,60例(60/71,84.51%)伴颈部淋巴结转移,14例(14/71,19.72%)伴中央区淋巴结转移,46例(46/71,64.79%)伴中央区+侧颈淋巴结转移。结论根据超声特征可有效鉴别儿童良恶性甲状腺结节。
Objective To investigate the value of ultrasound in differential diagnosis of benign and malignant thyroid nodules in children.Methods Ultrasonic manifestations of 120 children with thyroid nodules confirmed by pathology were retrospectively analyzed,and ultrasonic features of benign and malignant thyroid nodules were compared.Results Among120 cases,malignant nodules were detected in 71 cases(71/120,59.17%),while benign nodules were found in 49 cases(49/120,40.83%).There were significant differences of the shape,boundary,margin,composition,echo and calcification types between benign and malignant thyroid nodules(all P<0.05).The accuracy of the above ultrasonic features in diagnosis of malignant thyroid nodules was 80.00%(112/140),78.57%(110/140),78.57%(110/140),81.43%(114/140),82.86%(116/140),87.86%(123/140),the sensitivity was 68.29%(56/82),70.73%(58/82),73.17%(60/82),97.56%(80/82),90.24%(74/82),79.27%(65/82),and the specificity was 96.55%(56/58),89.66%(52/58),86.21%(50/58),58.62%(34/58),72.41%(42/58),100%(58/58).Among 71 cases of malignant thyroid nodules,60 cases(60/71,84.51%)were associated with cervical lymph node metastasis,14 cases(14/71,19.72%)were associated with central region lymph node metastasis,46 cases(46/71,64.79%)were simultaneously involved in the lateral compartment.Conclusion Ultrasound can effectively differentiate benign and malignant thyroid nodules in children.
Objective To investigate the value of ultrasound in differential diagnosis of benign and malignant thyroid nodules in children.Methods Ultrasonic manifestations of 120 children with thyroid nodules confirmed by pathology were retrospectively analyzed,and ultrasonic features of benign and malignant thyroid nodules were compared.Results Among120 cases,malignant nodules were detected in 71 cases(71/120,59.17%),while benign nodules were found in 49 cases(49/120,40.83%).There were significant differences of the shape,boundary,margin,composition,echo and calcification types between benign and malignant thyroid nodules(all P<0.05).The accuracy of the above ultrasonic features in diagnosis of malignant thyroid nodules was 80.00%(112/140),78.57%(110/140),78.57%(110/140),81.43%(114/140),82.86%(116/140),87.86%(123/140),the sensitivity was 68.29%(56/82),70.73%(58/82),73.17%(60/82),97.56%(80/82),90.24%(74/82),79.27%(65/82),and the specificity was 96.55%(56/58),89.66%(52/58),86.21%(50/58),58.62%(34/58),72.41%(42/58),100%(58/58).Among 71 cases of malignant thyroid nodules,60 cases(60/71,84.51%)were associated with cervical lymph node metastasis,14 cases(14/71,19.72%)were associated with central region lymph node metastasis,46 cases(46/71,64.79%)were simultaneously involved in the lateral compartment.Conclusion Ultrasound can effectively differentiate benign and malignant thyroid nodules in children.
引文
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[2] Niedziela M. Pathogenesis, diagnosis and management of thyroid nodules in children. Endocr Relat Cancer, 2006,13(2):427-453.
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[5] Francis GL,Waguespack SG, Bauer AJ, et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid, 2015,25(7):716-759.
[6] 李康,丛淑珍,李谊,等.超声探测甲状腺钙化模式的临床意义.中国医学影像技术,2007,23(3):379-381.
[7] Sherman SI. Thyroid carcinoma. Lancet, 2003,361(9356):501-511.
[8] Lee SJ, Lim GY, Kim JY, et al. Diagnostic performance of thyroid ultrasonography screening in pediatric patients with a hypothyroid, hyperthyroid or euthyroid goiter. Pediatr Radiol, 2016,46(1):104-111.
[9] Kwak JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data system for US features of nodules: A step in establishing better stratification of cancer risk. Radiology, 2011,260(3):892-899.
[10] Lu Z, Mu Y, Zhu H, et al. Clinical value of using ultrasound to assess calcification patterns in thyroid nodules. World J Surg, 2011,35(1):122-127.
[11] 燕山,詹维伟,周建桥.甲状腺与甲状旁腺的超声影像学.北京:科学技术文献出版社,2009:171.
[12] 金占强,何文,蔡文佳,等.超声多因素Logistic回归分析鉴别甲状腺结节的良恶性.中国医学影像技术,2016,32(5):646-650.
[13] Wu MH, Shen WT, Duh QY, et al. Prognostic significance of extranodal extension of regional lymph node metastasis in papillary thyroid cancer. Head Neck, 2015,37(9):1336-1343.
[14] Yüce I, Ca■li S, Bayram A, et al. Regional metastatic pattern of papillary thyroid carcinoma. Eur Arch Otorhinolaryngol, 2010,267(3):437-441.
[15] Zaydfudim V, Feurer ID, Griffin MR, et al. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery, 2008,144(6):1070-1078.
[2] Niedziela M. Pathogenesis, diagnosis and management of thyroid nodules in children. Endocr Relat Cancer, 2006,13(2):427-453.
[3] Gupta A, Samantha Ly, Castroneves LA, et al. A standardized assessment of thyroid nodules in children confirms higher cancer prevalence than in adults. J Clin Endocrinol Metab, 2013,98(8):3238-3245.
[4] Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016,26(1):1-133.
[5] Francis GL,Waguespack SG, Bauer AJ, et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid, 2015,25(7):716-759.
[6] 李康,丛淑珍,李谊,等.超声探测甲状腺钙化模式的临床意义.中国医学影像技术,2007,23(3):379-381.
[7] Sherman SI. Thyroid carcinoma. Lancet, 2003,361(9356):501-511.
[8] Lee SJ, Lim GY, Kim JY, et al. Diagnostic performance of thyroid ultrasonography screening in pediatric patients with a hypothyroid, hyperthyroid or euthyroid goiter. Pediatr Radiol, 2016,46(1):104-111.
[9] Kwak JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data system for US features of nodules: A step in establishing better stratification of cancer risk. Radiology, 2011,260(3):892-899.
[10] Lu Z, Mu Y, Zhu H, et al. Clinical value of using ultrasound to assess calcification patterns in thyroid nodules. World J Surg, 2011,35(1):122-127.
[11] 燕山,詹维伟,周建桥.甲状腺与甲状旁腺的超声影像学.北京:科学技术文献出版社,2009:171.
[12] 金占强,何文,蔡文佳,等.超声多因素Logistic回归分析鉴别甲状腺结节的良恶性.中国医学影像技术,2016,32(5):646-650.
[13] Wu MH, Shen WT, Duh QY, et al. Prognostic significance of extranodal extension of regional lymph node metastasis in papillary thyroid cancer. Head Neck, 2015,37(9):1336-1343.
[14] Yüce I, Ca■li S, Bayram A, et al. Regional metastatic pattern of papillary thyroid carcinoma. Eur Arch Otorhinolaryngol, 2010,267(3):437-441.
[15] Zaydfudim V, Feurer ID, Griffin MR, et al. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery, 2008,144(6):1070-1078.