超声显像与甲状腺癌病理类型的关系及良恶性结节并存的鉴别诊断  

Evaluation for the characteristics of the different pathologic types of thyroid carcinoma by ultrasonography and its diagnosis value in differentiation with benign neoplasms in thyroid multiple nodules cases

作　　者：李泉水[1] 姜健[1] 张家庭[1] 邹霞[1] 陈胜华[1] 郭国强[1] 粟晖[1] 李征毅[1] 

机构地区：[1]深圳市第二人民医院超声科,518035

出　　处：《中华医学超声杂志（电子版）》2009年第4期44-48,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：深圳市医学重点学科建设经费(2005CD6)

摘　　要：目的探讨不同病理类型甲状腺癌及良恶性结节并存甲状腺癌的声像图表现及鉴别诊断要点。方法对手术病理证实的182例甲状腺癌患者的222个癌结节的声像图表现进行分析,总结不同病理类型甲状腺癌的声像图特征,并对61例良恶性结节并存患者的96个良性结节和69个恶性结节声像图特征进行对比研究,找出良恶性结节的鉴别要点。结果182例中病理检出222个癌结节分别为乳头状癌202个、滤泡癌14个、髓样癌4个、未分化癌2个;术前超声显示内部呈低回声的癌结节分别为176个、7个、4个、2个;边界模糊的癌结节分别为175个、3个、3个、2个;出现钙化的癌结节分别为164个、0个、3个、2个;能探及血流信号的癌结节分别为198个、14个、4个、2个。61例良恶性结节并存患者的96个良性结节与69个恶性结节声像图比较,除后方回声外,其边界、内部回声、L/T、钙化及血流情况差异均有非常显著性(P均<0.01),L/T与内部回声情况与结节良恶性相关性较强(列联系数C值分别为0.601、0.508)。结论甲状腺乳头状癌、髓样癌、未分化癌声像图表现无明显差异,多数表现为边界模糊、有微钙化的低回声结节,而甲状腺滤泡癌多为边界较光整、较少出现微钙化的等至高回声结节。L/T与内部回声的特点在甲状腺多发结节良恶性鉴别诊断中有较大应用价值,而后方回声衰减与否则无鉴别诊断价值。Objective To evaluate the characteristics of the different pathologic types of thyroid carcinoma by ultrasonography and the differentiation between malignant and benign neoplasms in cases with thyroid multiple nodules. Methods The ultrasonographic characteristics of 182 patients with thyroid carcinoma, a total of 202 papillary carcinoma, 14 follicular carcinoma, 4 medullary carcinoma, 2 nondifferentiated carcinoma, which diagnosed by surgery and pathology, were analyzed according to their pathologic result and to summarize the sonographic features of different pathologic types of thyroid carcinoma. The characteristics of 69 malignant nodules and 96 benign nodules of 61 thyroid multiple nodules cases by ultrasonography were comparative studied to differentiate between benign and malignant nodules in thyroid multiple nodules cases. Results The these malignant nodules included 202 papillary carcinoma, 14 follicular carcinoma, 4 medullary carcinoma and 2 nondifferentiated carcinoma. The numbes of nodules which were hypoechoie were 176, 7, 4 and 2, respectively; and the numbes of nodules with circumscribed margin were 175, 3, 3 and 2, respectively; and the numbes of nodules with internal microcalcification were 164, 0, 3 and 2, respectively; and the numbes of nodules with vaseularity were 198, 14, 4 and 2 respectively. The differences of sonographic features between 69 malignant nodules and 96 benign nodules of 61 thyroid multiple nodules cases were statistically significant （ P 〈 0.01 ） , excluding posterior echo （ P = 0. 071 ）. Correspondingly, the correlation between L/T and internal echo and the properties of thyroid nodules were significant （ C = 0. 601, 0.508, respectively）. Conclusions There are no significant difference for sonographic characteristics among papillary carcinoma, medullary carcinoma and nondifferentiated carcinoma. The sonographic features were shown as follows： hypoechogenity, circumscribed margin and internal microcaleification. Comparatively,hyperechogenity, margin clear and n

关 键 词：超声检查 甲状腺肿瘤 甲状腺结节 病理学 

分 类 号：R736.1[医药卫生—肿瘤] R581[医药卫生—临床医学]