具有超声可疑恶性征象的甲状腺良性结节诊断误差的分析  

Analysis of Diagnostic Error of Benign Thyroid Nodules with Suspected Malignant Signs by Ultrasound

作　　者：鲍春旭 高文涛 马小萍[1] 王红[1] Bao Chunxu;Gao Wentao;Ma Xiaoping;Wang Hong(Department of Ultrasound Medicine,The First People's Hospital of Yinchuan,Yinchuan 750001,China)

机构地区：[1]银川市第一人民医院超声医学科,银川市750001

出　　处：《中国超声医学杂志》2023年第3期241-244,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 将超声检查中具有可疑恶性征象的甲状腺良性结节的声像图特征与穿刺病理结果进行分析,探讨诊断误差的原因,从而提高超声诊断准确度。方法 收集经超声检出具有可疑恶性征象的甲状腺结节,并行超声引导下穿刺活检,重点探讨病理提示良性结节的超声可疑恶性声像图与病理结果,分析诊断误差的原因。结果 超声检查中有可疑恶性征象的结节共268个,病理证实良性的结节共129个(48%),129个良性结节存在的可疑恶性征象主要包括:微钙化(56%)、纵横比>1(29%)、极低回声(9%)、边缘不光整(6%);病理结果主要包括:结节性甲状腺肿(76%)、甲状腺炎(12%)、甲状腺腺瘤样增生(6%)、甲状腺滤泡性腺瘤(6%)。结论 诊断误差主要包含以下因素:①甲状腺良性结节当发生出血、囊性变、坏死、纤维化、钙化、周围组织粘连等复杂病理过程时,声像图会出现良恶性征象混杂,易与甲状腺癌混淆;②超声医师对于甲状腺结节内微小钙化及结节回声的主观差异、纵横比测量切面的单一等。Objective The ultrasonographic characteristics of benign thyroid nodule with suspicious malignant signs in ultrasound examination and puncture pathological results were analyzed to explore the causes of diagnostic errors, so as to improve the accuracy of ultrasonic diagnosis. Methods Thyroid nodules with suspected malignant signs detected by high-frequency ultrasound in our hospital were collected, and ultrasound-guided puncture biopsy was conducted to focus on the ultrasonography and pathological results indicating benign nodules, and to analyze the causes of diagnostic errors. Results There were 268 nodules with suspected malignant signs in ultrasound examination, and 129(48%) were pathologically confirmed benign nodules. The suspected malignant signs in 129 benign nodules mainly included: microcalcification(56%), aspect ratio >1(29%), very low echo(9%), and irregular edge(6%). The main pathological findings included: nodular goiter(76%), thyroiditis(12%), thyroid adenomatous hyperplasia(6%), and thyroid follicular adenoma(6%). Conclusions The diagnostic errors mainly include the following factors:①When benign thyroid nodules occur complex pathological processes such as hemorrhage, cystic change, necrosis, fibrosis, calcification, and adhesion of surrounding tissues, the ultrasonography will appear mixed with benign and malignant signs, which is easy to be confused with thyroid cancer;②Sonographer’s subjective difference of thyroid nodular micro-calcification and nodular echo, single aspect ratio measurement section, etc.

关 键 词：超声 可疑恶性征象 甲状腺结节 穿刺病理 诊断误差 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581[医药卫生—诊断学]