钙化灶在甲状腺微小癌诊断中的价值

Value of Calcification in The Diagnosis of Thyroid Microcarcinoma

目的探讨钙化灶在甲状腺微小癌(TMC)诊断中的价值。方法对2009年1月～2010年12月在笔者医院手术治疗,行甲状腺超声检查发现结节直径<1.0cm并结节内伴有钙化灶,或经病理证实为TMC的134例患者的临床病理资料进行回顾性分析。结果 134例患者共184枚结节中,病理证实为TMC者107例共153枚,其中无钙化TMC91枚、微钙化64枚(TMC54枚、甲状腺肿9枚、慢性淋巴细胞性甲状腺炎1枚)、粗大钙化21枚(TMC5枚、甲状腺肿16枚)、孤立钙化斑7枚(TMC2枚、甲状腺肿4枚、慢性淋巴细胞性甲状腺炎1枚)、环状钙化1枚为TMC;34例TMC表现为多灶性癌。16例TMC有颈淋巴结转移。结论 TMC多无特异表现,微钙化是TMC诊断的一个特异性指标,但敏感性相对较差;TMC可有多发病灶及出现颈淋巴结转移,应注意外科手术方式的选择。

Objective To study the value of calcification in the diagnosis of thyroid microcarcinoma（TMC）. Methods Retrospec- tive analysis was used for those patients who accepted operation in our hospital from January 2009 to December 2010, and confirmed as TMC by pathology or suggested to have thyroid nodules that less than 1.0cm in diameter and have calcification by ultrasound. Results 184 nodules in 134 cases were calculated. Totally 153 nodules in 107 cases were confirmed as TMC. 91 nodules showed no calcification were confirmed as TMC, 64 nodules showed micro- calcification （54 TMCs, 9 thyroid goiters, l Hashimoto） , 21 nodules showed coarse calcification （5 TMCs, 16 thyroid goiters） , 7 nodules showed patchy calcification （2 TMCs, 4 thyroid goiters, 1 Hashimoto） , 1 nodule showed peripheral circular - calcification was confirmed as TMC. Totally 34 TMC cases showed multi - focuses. Totally 16 TMC cases had positive neck lymph node metastasis. Conclusion Most TMCs have no specific manifestation. Micro - calcification has high specificity in TMC diagnosis but has low sensitivity. Possible multi focuses and neck lymph node metastasis should be considered to choose proper surgi- cal treatment during operation.