桥本甲状腺炎背景下甲状腺癌的超声表现探讨

Exploration of ultrasonography in diagnosis of thyroid carcinoma with Hashimoto's thyroiditis

目的探讨甲状腺癌在桥本甲状腺炎(HT)实质背景下的超声表现特点。方法对79例HT伴甲状腺癌(HT组)和80例单纯性甲状腺癌(对照组)两组共计159个单发癌结节患者的术前彩色多普勒超声表现进行对比分析。结果按照腺体实质背景的灰阶超声表现,HT组79个癌结节,可分为均质型(32个)、斑片型(15个)、弥漫型(14个)、结节型(18个)。HT组中均质型、斑片型及结节型癌结节多表现为低回声,检出率分别为78.1%(25/32)、73.3%(11/15)及(14/18,77.8%);对照组癌结节低回声检出率为85.0%(68/80)。HT组中弥漫型癌结节多呈高回声,检出率为64.3%(9/14),低回声癌结节仅检出5例;对照组高回声癌结节检出率为3.8%(3/80),弥漫型癌结节与对照组癌结节高回声检出率比较差异有统计学意义(P<0.05)。HT组中均质型和斑片型癌结节内多为微小钙化,检出率分别为53.1%(17/32)及60.0%(9/15);对照组癌结节内微小钙化检出率为53.8%(43/80)。HT组中弥漫型及结节型癌结节内以粗大钙化为主,检出率分别为57.1%(8/14)及61.1%(11/18);对照组癌结节内粗大钙化检出率为21.3%(17/80),弥漫型及结节型癌结节与对照组癌结节内粗大钙化检出率比较差异有统计学意义(P<0.05)。结论分析不同类型HT的甲状腺实质背景及HT合并癌结节的超声表现,有助于提高HT背景下的甲状腺癌检出率。

Objective To investigate the ultrasonic feature of thyroid carcinoma with Hashimoto＇s thyroiditis （HT）. Methods The control group included 80 cases of thyroid carcinoma without any complications. The preoperative sonogram of the malignant nodules between the control goup（80 cases） and the HT group （79 eases） was compared. The sonographie characteristics of nodules were investigated. All cases were diagnosed by pathological assessment. Results According to the ultrasonic appearances of gland background, 79 cases in the HT group were classified into four types including homogeneous pattern（32） , focal hypoechoic pattern （15）, asystematic hypoeehoic pattern（14） and nodular pattern（18）. The sonographic appearances of malignant nodules for the asystematic hypoeehoie pattern HT were mostly with high-level echo （64.3% ,9/14） while the other were with bypoechoic echo. The calcifications were ≤2 mm in diameter among the control group （53.8% ,43/80） the homogeneousand pattern HT（53.1%, 17/32） and focal hypoechoic pattern HT （60.0% ,9/J5） , while those were mostly with 〉 2 mm in diameter in the asystematie hypoechoic pattern HT （57.1% ,8/14） and nodular pattern HT （61.1%, 11/18）. Conclusion The further study on sonographic characteristics of both HT background and thyroid carcinoma with HT can elevate the accuracy of diagnosis for thyroid carcinoma.