超声对甲状腺微小乳头状癌与微小结节性甲状腺肿的鉴别

Ultrasound identification of papillary thyroid microcarcinoma and thyroid micronodular goiter

目的探讨甲状腺微小乳头状癌(PTMC)与微小结节性甲状腺肿(MNG)的超声诊断要点,以提高甲状腺微小结节的诊断准确率。方法对比分析经手术病理证实的38例PTMC(共45个结节)和44例MNG(共91个结节)患者的高频二维及彩色多普勒声像特征。结果虽然部分PTMC与MNG的声像图表现可相互重叠及并发,但PTMC组与MNG组结节的内部回声(χ2=53.279,P﹤0.05)、回声水平(χ2=45.519,P﹤0.05)、纵横比(χ2=50.483,P﹤0.05)、微钙化(χ2=25.513,P﹤0.05)、数目(χ2=9.584,P﹤0.05)、边界(χ2=20.838,P﹤0.05)、血流信号(χ2=33.009,P﹤0.05)等声像特征的差异有统计学意义。PTMC易较早出现颈部淋巴结转移。结论对PTMC与MNG的声像特征进行逐项对比分析,可提高两者的鉴别诊断水平,为临床选择治疗方案提供重要信息。

Objective Objective To investigate the sonographic features of papillary thyroid microcarcinoma(PTMC) and thyroid micronodular goiter(MNG), and to improve the diagnostic accuracy of thyroid nodules. Methods High-frequency two-dimensional and color Doppler sonographic features of 38 PTMC(including 45 nodules) cases and 44 MNG(including 91 nodules) cases were confirmed by surgery pathology. Their sonographic features were compared and analyzed. Results Although some PTMC and MNG sonographic manifestations were overlapping and concurrent, there existed significant differences in the sonograghic features including the internal echo(χ2=53.279, P<0.05), echo level(χ2=45.519, P<0.05), longitudinal diameter/transverse diameter ratio(χ2=50.483, P<0.05), microcalcification(χ2=25.513, P<0.05), number(χ2=9.584, P<0.05), boundary(χ2=20.838, P<0.05), and blood flow signals(χ2=33.009, P<0.05). The cervical lymph node metastasis appeared earlier in PMTC. Conclusion The item-to-item comparative analysis of PTMC and MNG sonographic features can improve the differential diagnosis of PTMC and MNG, providing important information for the clinical decision.