180例甲状腺结节显像与病理分析

A Comparative analysis of scintigraphy with pathology in 180 patients with thyroid nodules

目的 :评价甲状腺显像鉴别诊断甲状腺结节良、恶性的临床价值。方法 :180例甲状腺结节患者行甲状腺99mTcO-4 显像 ,并将其与病理结果进行对比研究。结果 :甲状腺结节显像呈冷结节者 15 8例 ( 87 8% ) ,温结节者 7例( 3 9% ) ,热结节者 3例 ( 1 7% ) ,甲状腺不显影或显影极淡者 12例 (其病理诊断为“亚急性甲状腺炎”) ( 6 7% )。冷结节癌发生率 18 4% ( 2 9/ 15 8例 ) ,1例热结节手术病理诊断乳头状癌 0～ 1级。良、恶性甲状腺结节患者在甲状腺功能及大小上存在显著性差异 ( χ2 =5 70 ,11 49;P <0 0 5 ) 2 0岁以下患者发生癌变的比率较大 ( χ2 =7 0 7;P <0 0 5 )。甲状腺良性病变 15 0例 ,其中 5 4例伴囊性变 ,囊变率 3 6 % ;甲状腺癌 3 0例 ,仅 2例伴囊性变 ,囊变率 6 7%。结论 :甲状腺显像仅从影像特征去区分甲状腺结节的良、恶性还很困难 ,但可结合临床及其它辅助检查资料作出初步诊断 ,并能避免某些不必要的有创性检查或治疗。

Objective:To assess the clinical value of thyroid scintigraphy in the differential diagnosis of benign and malignant thyroid nodular lesions.Methods:180 patients with thyroid nodules were examined with 99m TcO - 4 thyroid imaging.The results were compared with the pathologic findings.Results:Of 180 patients with thyroid imaging,158 showed cold nodules (87 8%),7 showed warm nodules (3 9%) and 3 with hot nodules (1.7%),12 cases who showed very light images or even nonvisualized gland were proved to have sabacute thyroiditis (6 7%).29/158 (18.4%) cold nodules were malignant and one hot nodule was identified as papillary adenocarcinoma (grade 0～Ⅰ).The differences between the benign and malignant lesions in respect of the thyroid function and size of nodules were significant (χ 2=5 70,11 49, P <0 05).There was higher probability of malignant transformation in patients under 20 years (χ 2=7 07; P <0 05).Among the 150 patients with benign leseons,cystic degeneration occured in 36%(54/150). 30 of 180 patients were thyroid carcinoma,with the rate of cystic degeneration of 6 7% (2/30).Conclusions:It is very difficult to differentiate the benign from malignant nodules when only depending the features of thyroid scintigraphy.It is helpful when scintigraphy combine with clinical data and other examinations in diagnosis of thyroid nodules.The thyroid scanning is also helpful in avoiding unnecessary and traumatic interventions.