甲状腺癌超声图像特点及误诊分析  

Characteristics of Ultrasound Images of Thyroid Cancer and Misdiagnosis Analysis

作　　者：周瑞麒 周变 ZHOU Ruiqi;ZHOU Bian(Department of Function,the Affiliated Hospital of Yuncheng Nursing Vocational College,Yuncheng,Shanxi 044000,China)

机构地区：[1]运城护理职业学院附属医院功能科,山西运城044000

出　　处：《临床误诊误治》2025年第4期22-26,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析甲状腺癌超声图像特点及临床误诊原因,总结防范误诊方法。方法回顾分析2021年2月至2024年2月经病理证实的甲状腺癌患者80例,分析其术前超声图像特征,总结误诊原因。结果本组80例共发现恶性结节86个,术后经病理证实乳头状癌78个,滤泡癌5个,髓样癌2个,鳞癌1个。超声诊断84个结节,病理诊断符合率为72.09%(62/86),漏诊率为2.33%(2/86),误诊率为25.58%(22/86)。22个误诊结节中,16个误诊为结节性甲状腺肿,6个误诊为腺瘤;经病理证实17个为乳头状癌,4个为滤泡癌,1个为髓样癌。误诊结节超声表现为边界清晰12个(54.55%)、可见晕征9个(40.91%)、低/极低回声15个(68.18%)、微钙化7个(31.82%)、纵横比<114个(63.64%)。误诊结节血流分级以Ⅰ级40.91%、0级27.27%为主。误诊结节与未误诊结节在边界、晕征、低/极低回声、微钙化、纵横比方面以及血流分级方面比较均存在差异(P<0.05)。结论超声诊断甲状腺癌误诊率仍然处于较高水平,部分甲状腺恶性与良性结节超声图像相似,当恶性结节声像图表现为良性结节特征、恶性结节小且合并多发良性结节时应综合分析判断,以减少漏误诊。Objective To analyze the characteristics of ultrasound images of thyroid cancer and the causes of clinical misdiagnosis,and to summarize the prevention methods of misdiagnosis.Methods Eighty patients with thyroid cancer confirmed by pathology from February 2021 to February 2024 were retrospectively analyzed,characteristics of their preoperative ultrasound images were analyzed,and the causes of misdiagnosis were summarized.Results A total of 86 malignant nodules were found in these 80 patients.After operation,78 papillary carcinoma,5 follicular carcinoma,2 medullary carcinoma and 1 squamous carcinoma were pathologically confirmed.Eighty-four nodules were diagnosed by ultrasound,the coincidence rate of pathological diagnosis was 72.09%(62/86),the missed diagnosis rate was 2.33%(2/86),and the misdiagnosis rate was 25.58%(22/86).Of the 22 nodules misdiagnosed,16 were misdiagnosed as nodular goiter and 6 as adenoma.Pathological examination confirmed 17 papillary carcinoma,4 follicular carcinoma and 1 medullary carcinoma.The ultrasonographic manifestations of misdiagnosed nodules included 12(54.55%)with clear boundary,9(40.91%)with visible halo,15(68.18%)with low/very low echo,7(31.82%)with microcalcification,and 14(63.64%)with aspect ratio<1.The misdiagnosed nodular blood supply was mainly gradeⅠ40.91%and grade 027.27%.There were significant differences in boundary,halo sign,low/very low echo,microcalcification,aspect ratio and blood flow grading between misdiagnosed and non-misdiagnosed thyroid nodules(P<0.05).Conclusion The misdiagnosis rate of ultrasonic diagnosis of thyroid cancer is still at a high level,and some ultrasound images of malignant and benign thyroid nodules are similar.When the ultrasound images of malignant nodules show the characteristics of benign nodules,and the malignant nodules are small and complicated with multiple benign nodules,comprehensive analysis and judgment should be made to reduce misdiagnosis.

关 键 词：甲状腺癌 误诊 超声诊断 图像特点 鉴别诊断 甲状腺结节 甲状腺腺瘤 结节性甲状腺肿 

分 类 号：R736.1[医药卫生—肿瘤]