彩色多普勒超声鉴别甲状腺结节良恶性价值的再探讨

Reassessment for the diagnosis value of color Doppler ultrasound in thyroid nodules

目的探讨彩色多普勒超声在甲状腺结节良恶性鉴别中的价值。方法回顾性分析857个以实性及实性为主的甲状腺结节,评估每个结节的彩色多普勒超声特征,包括血管模式和血供程度。根据结节大小及结节内部回声又各分成2个亚组(≤1cm组和>1cm组、极低/低回声组和中等/高回声组)。所有结节根据病理结果分成良性组和恶性组。经统计学检验,分析彩色多普勒超声特征在鉴别甲状腺良恶性方面的作用。结果 857个实性及实性为主的结节中,良恶性结节均以混合血管型为主,良性结节以高血供为主,恶性结节则以低血供为主。根据结节大小分组,恶性结节在≤1cm组和>1cm组中均以低血供为主,但结节变大,高血供所占比例上升;良性结节在≤1cm组中以低血供为主,在>1cm组中以高血供为主。根据内部回声分组,恶性结节在极低/低回声组和中等/高回声组中均以低血供为主;良性结节在极低/低回声组中以低血供为主,在中等/高回声组中以高血供为主。结论不同分组的血管模式和血供程度在良恶性结节中存在一定的重叠性,对鉴别甲状腺结节的良恶性意义有限。

Objective To evaluate if color Doppler ultrasound （US） is valuable for differentiating benign from malignant thyroid nodules. Methods A total of 857 thyroid nodules with solid or predominantly solid internal content diagnosed at surgery were included in this study. The flow pattern and blood supply were evaluated. The relationships between the feature with color Doppler US and malignancy were assessed according to size（ ≤ 1 cm in size and 〉 1 cm in size） and eehogenieity of the nodule （hypoeehoic/markedly hypoechoie and hyperechoic/isoechoic）. Results Of 857 nodules, mixed flow pattern was observed in the majority of benign and malignant nodules, and hypervaseularity was more frequently found in benign nodules while hypovascularity in malignant nodules. In nodules 〈~ 1 cm in size or 〉 1 cm, hypovascularity was more frequently observed in malignant nodules, and The percentage of hypervascularity increased along with an increased size of nodules. In both hypoechoic/markedly hypoechoic and hyperechoic/isoechoic group, malig nant nodules were mainly observed with hypovascularity. In hypoechoic/markedly hypoechoic group, the benign nodules were mainly found with hypovascularity while hypervascularity in hyperechoic/isoechoic group. Conclusion The flow pattern and blood supply can be overlapped in benign and malignant nodules. Therefore these features are not enough for identification of benign and malignant nodules.