甲状腺结节合并钙化与甲状腺癌关系的临床研究

A study on the relationship between thyroid nodules with calcification and thyroid carcinoma

目的 探讨甲状腺结节合并钙化与甲状腺癌的关系及其对甲状腺癌高危人群筛选的临床意义.方法 回顾性分析2006年3月至2009年3月行甲状腺手术的1771例患者中甲状腺结节合并不同类型钙化的甲状腺癌发生率.结果 本组病例中恶性肿瘤500例,甲状腺癌的钙化发生率为68.4%,良性疾病中的钙化发生率为27.0%,差异有统计学意义（χ2=259.5,P＜0.05）.微钙化诊断甲状腺癌的特异性为89.4%,阳性预测值为66.3%,与其在良性疾病中的差异有统计学意义（χ2=368.6,P＜0.01）.年龄＜45岁的甲状腺癌发生率为39.2%,≥45岁的甲状腺癌发生率为22.9%,差异有统计学意义（χ2=51.12,P＜0.05）.单发结节的甲状腺癌发生率为31.7%,多发结节为26.4%,两者差异有统计学意义（χ2=4.766,P＜0.05）.B超显示淋巴结肿大最终证实为甲状腺癌转移的比例为26.8%.结论 钙化尤其是微钙化对于诊断甲状腺癌的特异性较高,具有重要的临床意义.甲状腺癌的高危人群包括：甲状腺结节合并微钙化、年龄＜45岁及单发结节.

Objective To investigate the relationship between thyroid nodules with calcification and thyroid carcinoma and its significance in the screening of thyroid carcinoma in high risk group.Methods The clinical data of 1771 patient undergoing surgery for thyroid nodules from March, 2006 to March, 2009 in Huashan Hospital, Fudan University were retrospectively analyzed. Results Among 1771 patients, 500 were finally identified as having malignant tumors. Incidence of calcification in thyroid carcinoma was 68. 4%, and that in benign thyroid nodules was 27.0% （ χ2 = 259. 5, P 〈 0. 05 ）. The specificity of microcalcification for the diagnosis of carcinoma was 89. 4%, and its positive predictive value was 66. 3% （ χ2 = 368.6, P 〈 0. 01 ）. The incidence of thyroid carcinoma in patients 〈 45 years was 39.2%, while that in patients ≥ 45 years was 22.9% （ χ2 = 51.12, P 〈 0. 05 ）. The incidence of carcinoma in patients of single thyroid nodule was 31.7% and that in those with multiple nodules was 26. 4% （χ2 =4. 766,P 〈 0. 05）. Metastasis was pathologically diagnosed in 26. 8% of lymph nodes found by preoperative ultrasonography. Conclusions The specificity of thyroid nodule calcification, especially microcalcification is high for the diagnosis of thyroid carcinoma. High-risk index for carcinoma includes thyroid nodules with microcalcification, 〈 45 years old and single thyroid nodule.