超声诊断甲状腺结节钙化与甲状腺癌相关性分析
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摘要
目的:探讨超声诊断甲状腺结节钙化与甲状腺癌的相关性。方法:回顾性分析玉溪市人民医院2010年1月至2017年10月收治的229例患者甲状腺癌结节的超声声像图,对甲状腺结节内是否存在钙化以及钙化的特征分析并统一标准。结果:恶性结节超声钙化灶的发生率为64.19%(147/229),无钙化灶的发生率为35.81%(82/229),组间比较差异有统计学意义(P<0.05)。恶性结节钙化组中微钙化发生率为95.92%(141/147),显著高于粗钙化、环状钙化的发生率4.08%(6/147),组间比较差异有统计学意义(P<0.05)。结论:甲状腺结节内微钙化对超声诊断甲状腺癌具有较高的临床诊断价值,其他粗大、环状钙化也存在恶性病变的风险,必要时对可疑结节进行细针穿刺细胞学(FNA)检查,可提高诊断的准确性。
Objective: To explore the correlation between ultrasound-detected calcification in thyroid nodules and thyroid cancer.Methods: We conducted a retrospective review of ultrasonic images of thyroid nodules of 229 patients with thyroid cancer hospitalized in the People's Hospital of Yuxi from Jan. 2010 to Oct. 2017, and applied the same criteria to evaluate whether there were ultrasound calcifications in thyroid nodules and analyzed the features of calcification. Results: Ultrasound calcifications were detected in 147(64.19%)of all cancerous nodules, while in 82 of the 229(35.81%)nodules no ultrasound calcifications were found. The differences between the two groups of data were statistically significant(P<0.05). Among the patients with ultrasound calcifications the incidence of micro-calcifications was 95.92%(141/147), which was clearly higher than the incidence of coarse calcifications and ring calcifications of 4.08%(6/147). There was statistically significant difference(P<0.05). Conclusion: There is a great clinical value in diagnosing thyroid cancer by detecting ultrasound micro-calcifications in thyroid nodules. But the risk of malignant nodules in coarse calcifications and ring calcifications is still high. Thus, in order to promote accurate diagnosis, FNA should be performed on the ultrasonographically suspicious nodules if necessary.
Objective: To explore the correlation between ultrasound-detected calcification in thyroid nodules and thyroid cancer.Methods: We conducted a retrospective review of ultrasonic images of thyroid nodules of 229 patients with thyroid cancer hospitalized in the People's Hospital of Yuxi from Jan. 2010 to Oct. 2017, and applied the same criteria to evaluate whether there were ultrasound calcifications in thyroid nodules and analyzed the features of calcification. Results: Ultrasound calcifications were detected in 147(64.19%)of all cancerous nodules, while in 82 of the 229(35.81%)nodules no ultrasound calcifications were found. The differences between the two groups of data were statistically significant(P<0.05). Among the patients with ultrasound calcifications the incidence of micro-calcifications was 95.92%(141/147), which was clearly higher than the incidence of coarse calcifications and ring calcifications of 4.08%(6/147). There was statistically significant difference(P<0.05). Conclusion: There is a great clinical value in diagnosing thyroid cancer by detecting ultrasound micro-calcifications in thyroid nodules. But the risk of malignant nodules in coarse calcifications and ring calcifications is still high. Thus, in order to promote accurate diagnosis, FNA should be performed on the ultrasonographically suspicious nodules if necessary.
引文
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[9]林文金,薛恩生,刘世友,等.高频超声对伴环形钙化甲状腺结节的诊断价值[J].中国超声医学杂志,2018(2):105-107.
[10]丛淑珍,尚诗瑶,冯占武,等.超声诊断伴周边环形钙化甲状腺结节良恶性的价值[J].中国医学影像技术,2017,33(3):390-393.
[11]姚珊.系统评价甲状腺结节诊断的Meta分析[D].西安:第四军医大学,2013.
[12]张波,徐景竹,吴琼.2015年美国甲状腺学会《成人甲状腺结节与分化型甲状腺癌诊治指南》解读:超声部分[J].中国癌症杂志,2016,26(1):19-24.
[13]LACOUT A,CHEVENET C,THARIAT J,et al.Thyroid calcifications:a pictorial essay[J].J Clin Ultrasound,2016,44(4):245-251.
[14]汪锴,康嗣如,管云飞,等.大理汉族和白族甲状腺恶性肿瘤的临床研究[J].大理大学学报,2017,2(4):52-55.
[15]郭万学.超声医学[M].北京:人民军医出版社,2011.
[2]中国抗癌协会甲状腺癌专业委员会.甲状腺微小乳头状癌诊断与治疗中国专家共识(2016版)[J].中国肿瘤临床,2016,43(12):526.
[3]张瑛,王志明,李新营,等.超声下甲状腺结节内微钙化对良恶性的鉴别及其与甲状腺乳头状癌临床病理特征的关系[J].中国普通外科杂志,2014,23(11):1548-1552.
[4]LU Z,MU Y,ZHU H,et al.Clinical value of using ultrasound to assess calcification patterns in thyroid nodules[J].World J Surg,2011,35(1):122-127.
[5]SHIN J H.Ultrasonographic imaging of papillary thyroid carcinoma variants[J].Ultrasonography,2017,36(2):103-110.
[6]WOLI?SKI K,SZKUDLAREK M,SZCZEPANEK-PA-RULSKA E,et al.Usefulness of different ultrasound features of malignancy in predicting the type of thyroid lesions:a meta-analysis of prospective studies[J].Polish Archives of Internal Medicine,2014,124(3):97-104.
[7]刘如玉,张波.美国放射学会甲状腺结节影像报告系统和影像偶发甲状腺结节管理系列白皮书解读[J].中国癌症杂志,2018,28(2):88-97.
[8]WANG Y,LEI K R,HE Y P,et al.Malignancy risk stratification of thyroid nodules:comparisons of four ultrasound Thyroid Imaging Reporting and Data Systems in surgically resected nodules[J].Sci Rep,2017,7(1):11560.
[9]林文金,薛恩生,刘世友,等.高频超声对伴环形钙化甲状腺结节的诊断价值[J].中国超声医学杂志,2018(2):105-107.
[10]丛淑珍,尚诗瑶,冯占武,等.超声诊断伴周边环形钙化甲状腺结节良恶性的价值[J].中国医学影像技术,2017,33(3):390-393.
[11]姚珊.系统评价甲状腺结节诊断的Meta分析[D].西安:第四军医大学,2013.
[12]张波,徐景竹,吴琼.2015年美国甲状腺学会《成人甲状腺结节与分化型甲状腺癌诊治指南》解读:超声部分[J].中国癌症杂志,2016,26(1):19-24.
[13]LACOUT A,CHEVENET C,THARIAT J,et al.Thyroid calcifications:a pictorial essay[J].J Clin Ultrasound,2016,44(4):245-251.
[14]汪锴,康嗣如,管云飞,等.大理汉族和白族甲状腺恶性肿瘤的临床研究[J].大理大学学报,2017,2(4):52-55.
[15]郭万学.超声医学[M].北京:人民军医出版社,2011.