超声对桥本氏甲状腺炎甲状腺微小结节良恶性的鉴别诊断
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摘要
目的探讨彩色多普勒超声对桥本氏甲状腺炎(HT)背景下甲状腺微小结节良恶性的鉴别诊断价值。方法回顾性分析我院2014年1月至2017年6月收治的HT合并甲状腺微小结节103例(108枚)患者的超声资料。根据术后病理将微小结节分为良性组和恶性组,采用2检验和Fisher确切概率法比较两组患者的超声图像特征,包括结节的形状、边缘、边界、晕环、微钙化、纵横比、回声类型、血管分布、血流信号以及后方回声。以术后病理作为金标准,计算出超声诊断HT合并甲状腺微小乳头状癌(PTMC)的敏感性、特异性、准确性、阳性预测值以及阴性预测值。结果 HT背景下108枚甲状腺微小结节中,70枚为恶性(均为PTMC),38枚为良性。PTMC组与甲状腺微小良性结节组的形状、边缘、微钙化、回声类型、血流信号及血管分布差异具有统计学意义(P<0.05),而边界、晕环、纵横比及后方回声差异均无统计学意义(P>0.05)。超声诊断HT合并PTMC的敏感性、特异性、准确性、阳性预测值及阴性预测值分别为94.3%、31.6%、72.2%、71.7%、75%。结论超声在HT背景下甲状腺微小结节良恶性的鉴别诊断中具有重要的参考价值,但HT背景下PTMC的部分典型恶性征象不明显。
Objective To investigate the value of ultrasonography in the differential diagnosis of benign and malignant thyroid micronodules under the background of Hashimoto thyroiditis( HT). Methods The retrospective study data was collected from January2014 to June 2017 in our hospital. A total of 108 thyroid micronodules with 103 HT cases which were pathologically confirmed were included in this study. According to postoperative pathology,thyroid micronodules were divided into benign and malignant groups. Chi-square test and Fisher's exact probability method were used to compare the sonographic characteristics of the two groups. The sonographic characteristics included nodule shape,margin,border,acoustic halo,microcalcifications,aspect ratio,echo type,blood vessel distribution,blood flow signal and rear acoustic were analyzed. With surgical pathology as the gold standard,computing the value of ultrasonography in the diagnosis of papillary thyroid microcarcinoma( PTMC) with HT,including the sensitivity,specificity,diagnostic accuracy,positive predictive value and negative predictive value. Results IOf 108 thyroid micronodules under the background of HT,there were 70 malignant thyroid nodules( all PTMC),and 38 benign thyroid nodules. There was significant difference in the shape,margin,microcalcification,echo type,blood flow signal and blood vessel distribution between PTMC and benign micronodules( P < 0.05). There was no significant difference in border,acoustic halo,aspect ratio and rear acoustic( P > 0. 05). The sensitivity,specificity,diagnostic accuracy,positive predictive value and negative predictive value of the ultrasound diagnosis of PTMC with HT were 94.3%,31. 6%,72. 2%,71. 7%,75%,respectively. Conclusion Ultrasonography has important reference value in the differential diagnosis of benign and malignant thyroid micronodules under the background of HT,but some classic ultrasound malignant features became less effective in patients with HT.
Objective To investigate the value of ultrasonography in the differential diagnosis of benign and malignant thyroid micronodules under the background of Hashimoto thyroiditis( HT). Methods The retrospective study data was collected from January2014 to June 2017 in our hospital. A total of 108 thyroid micronodules with 103 HT cases which were pathologically confirmed were included in this study. According to postoperative pathology,thyroid micronodules were divided into benign and malignant groups. Chi-square test and Fisher's exact probability method were used to compare the sonographic characteristics of the two groups. The sonographic characteristics included nodule shape,margin,border,acoustic halo,microcalcifications,aspect ratio,echo type,blood vessel distribution,blood flow signal and rear acoustic were analyzed. With surgical pathology as the gold standard,computing the value of ultrasonography in the diagnosis of papillary thyroid microcarcinoma( PTMC) with HT,including the sensitivity,specificity,diagnostic accuracy,positive predictive value and negative predictive value. Results IOf 108 thyroid micronodules under the background of HT,there were 70 malignant thyroid nodules( all PTMC),and 38 benign thyroid nodules. There was significant difference in the shape,margin,microcalcification,echo type,blood flow signal and blood vessel distribution between PTMC and benign micronodules( P < 0.05). There was no significant difference in border,acoustic halo,aspect ratio and rear acoustic( P > 0. 05). The sensitivity,specificity,diagnostic accuracy,positive predictive value and negative predictive value of the ultrasound diagnosis of PTMC with HT were 94.3%,31. 6%,72. 2%,71. 7%,75%,respectively. Conclusion Ultrasonography has important reference value in the differential diagnosis of benign and malignant thyroid micronodules under the background of HT,but some classic ultrasound malignant features became less effective in patients with HT.
引文
[1]张金成.人力牵引结合推拿手法治疗顽固性腰椎间盘突出症临床观察[J].中国中医骨伤科杂志,2011,19(2):51-51.
[1]LIVOLSI V A.The pathology of autoimmune thyroid disease:a review[J].Thyroid,1994,4(3):333-339.
[2]丛淑珍,冯占武,吴丽桑,等.超声在桥本氏甲状腺炎诊断中的应用价值[J].中国超声医学杂志,2015,31(9):840-841.
[3]ZHANG Y,DAI J Q,WU T T,et al.The study of the coexistence of Hashimoto's thyroiditis with papillary thyroid carcinoma[J].J Cancer Res Clin Oncol,2014,140(6):1021-1026.
[4]孙辉,李芳.桥本甲状腺炎合并微小癌外科治疗对策[J].中国实用外科杂志,2016,36(5):511-515.
[5]WU G H,ZOU D Z,CAI H Y,et al.Ultrasonography in the diagnosis of Hashimoto's thyroiditis[J].Front Biosci(Landmark Ed),2016,21(1):1006-1012.
[6]LIU Y,LI C,ZHAO W,et al.Hashimoto's thyroiditis is an important risk factor of papillary thyroid microcarcinoma in younger adults[J].Horm Metab Res,2017,49(10):732-738.
[7]杨帆,郭美金,吴斌,等.超声对甲状腺微小乳头状癌的诊断价值[J].临床超声医学杂志,2012,14(5):342-344.
[8]杨志芳,詹维伟,周建桥.超声对桥本甲状腺炎甲状腺微小乳头状癌的诊断价值[J].中华医学超声杂志(电子版),2014,11(10):840-844.
[9]MOON H J,KWAK J Y,KIN E K,et al.A taller-than-wide shape in thyroid nodules in transverse and longitudinal ultrasonographic planes and the prediction of malignancy[J].Thyroid,2011,21(11):1249-1253.
[10]申兴平,沈严严.甲状腺良恶性结节超声特征及其Logistic回归分析[D].南华大学2015.
[11]杨金燕,王玲,吴媛嫒.超声对甲状腺良恶性结节的鉴别诊断[J].安徽医学,2009,30(12):1448-1450.
[12]李晨,郝玉芝,王勇,等.超声造影在甲状腺微小实性结节良恶性鉴别诊断中的价值[J].临床超声医学杂志,2015,17(7):453-456.
[1]LIVOLSI V A.The pathology of autoimmune thyroid disease:a review[J].Thyroid,1994,4(3):333-339.
[2]丛淑珍,冯占武,吴丽桑,等.超声在桥本氏甲状腺炎诊断中的应用价值[J].中国超声医学杂志,2015,31(9):840-841.
[3]ZHANG Y,DAI J Q,WU T T,et al.The study of the coexistence of Hashimoto's thyroiditis with papillary thyroid carcinoma[J].J Cancer Res Clin Oncol,2014,140(6):1021-1026.
[4]孙辉,李芳.桥本甲状腺炎合并微小癌外科治疗对策[J].中国实用外科杂志,2016,36(5):511-515.
[5]WU G H,ZOU D Z,CAI H Y,et al.Ultrasonography in the diagnosis of Hashimoto's thyroiditis[J].Front Biosci(Landmark Ed),2016,21(1):1006-1012.
[6]LIU Y,LI C,ZHAO W,et al.Hashimoto's thyroiditis is an important risk factor of papillary thyroid microcarcinoma in younger adults[J].Horm Metab Res,2017,49(10):732-738.
[7]杨帆,郭美金,吴斌,等.超声对甲状腺微小乳头状癌的诊断价值[J].临床超声医学杂志,2012,14(5):342-344.
[8]杨志芳,詹维伟,周建桥.超声对桥本甲状腺炎甲状腺微小乳头状癌的诊断价值[J].中华医学超声杂志(电子版),2014,11(10):840-844.
[9]MOON H J,KWAK J Y,KIN E K,et al.A taller-than-wide shape in thyroid nodules in transverse and longitudinal ultrasonographic planes and the prediction of malignancy[J].Thyroid,2011,21(11):1249-1253.
[10]申兴平,沈严严.甲状腺良恶性结节超声特征及其Logistic回归分析[D].南华大学2015.
[11]杨金燕,王玲,吴媛嫒.超声对甲状腺良恶性结节的鉴别诊断[J].安徽医学,2009,30(12):1448-1450.
[12]李晨,郝玉芝,王勇,等.超声造影在甲状腺微小实性结节良恶性鉴别诊断中的价值[J].临床超声医学杂志,2015,17(7):453-456.