超声诊断甲状腺乳头状癌并存桥本甲状腺炎的临床价值

The clinical value of ultrasound diagnosis on papillary thyroid carcinoma coexisted with Hashimotothyroiditis

目的探讨超声对甲状腺乳头状癌（PTC）并存桥本甲状腺炎（HT）的诊断价值。方法2006年1月至2011年12月经手术病理证实的PTC患者2144例，其中265例并存HT（Prc并存HT组），1879例未并存HT（PTC未并存HT组），对两组患者术前超声资料进行回顾性分析。结果PTC并存HT组癌结节与PTC未并存HT组癌结节多表现为形态不规则、边界不清楚等超声声像表现（P〉0．05）；PTC未并存FIT组癌结节多表现为低回声伴微钙化，PTC并存HT组癌结节则表现为内部回声多样化伴微钙化为主、粗钙化占一定比例（P〈0．01）；PTC并存HT组癌结节血流较PTC未并存HT组并不丰富，主要表现为血流紊乱；与PTC未并存FIT组相比，PTC并存HT组癌结节超声诊断准确率低[52．8％（140／265）比75．O％（1409／1879）]（P〈0．01）。PTC未并存HT组超声诊断淋巴结转移符合率[84．0％（487／580）]高于PTC并存HT组[74．8％（77／103）]，差异有统计学意义（P〈0．05）。结论对于HT病变基础上发现的低回声实性结节、边界不清楚、伴微钙化，应高度怀疑恶变可能；而对于高回声实性结节或粗钙化结节，亦应警惕恶性可能，应进一步观察周围回声及内部血流等特征，综合分析、判断其是否有恶变的可能，尽可能减少对该病的误诊、漏诊。

Objective To investigate the diagnostic value of ultrasound on patients with papillary thyroid carcinoma （PTC） coexisted with Hashimoto thyroiditis （HT）. Methods The preoperative ultrasonography data of 2144 cases with PTC from January 2006 to December 2011 who treated with operation and diagnosed by pathology were analyzed retrospectively. Among them, 265 cases coexisted with HT （PTC coexisted with HT group）, 1879 cases were not coexisted with HT （non-PTC coexisted with HT group）. Results Most of the cancerous nodes in two groups exhibited in the ultrasonographic performance just like irregular shape,unclear boundary and so on （P 〉 0.05 ）. Most of the cancerous nodes in non-PTC coexisted with FIT group exhibited hypoechoic nodules with microcalcifications, those in PTC coexisted with HT group exhibited various internal echoes with mainly microealcifications,and the coarse calcification occupied a certain proportion（P 〈 0.01 ）. The cancerous nodes in PTC coexisted with HT group were not rich in blood flow compared with non-PTC coexisted with HT group, but mostly exhibited blood disorders. When compared with non-PTC coexisted with HT group, the rate of ultrasound diagnosis in PTC coexisted with HT group was lower [ 52.8 %（ 140/265 ） vs.75.0 % （1409/1879）, P 〈 0.01 ], and the false positive rate in lymphnode was higher [84.0% （487/580） vs. 74.8% （77/103）] （P 〈0.05）. Conclusions The nodules are malignant when they appear as hypoeehoic solid nodules, have unclear boundary and have mierocalcifieations should be highly suspected. The hyperechoic solid nodules or coarse calcification nodules should also be awared and taken further observation of the eharaeteristics around the echoes and the internal blood flow, making comprehensive analysis to determine whether it could be malignant transformation and try best to reduce the misdiagnosis and missed diagnosis rates of this disease.