儿童及青少年甲状腺癌的超声诊断

Ultrasound Diagnosis of Children and Teenagers Thyroid Carcinoma

目的：了解儿童及青少年甲状腺癌的临床和超声图像特征，提高超声诊断水平。方法：回顾性分析2004年1月-2011年12月期间20岁以下的甲状腺肿瘤141例，以病理为诊断的金标准，通过logistic回归分析了解各超声图像特征的相对危险度并建立预测儿童及青少年甲状腺癌的logistic多元回归模型。结果：141例甲状腺结节中甲状腺癌62例，甲状腺良性结节79例。9项特征最终有4项进入logistic多元回归模型，相对危险度从大到小排序是：结节内Ⅲ型血流（19．607）〉形态不规则（10．389）〉结节呈低回声（6．174）〉结节内微钙化（5．529）。联合指标筛查儿童及青少年甲状腺癌能力最强的是形态不规则＋肿瘤内Ⅲ型血流。结论：彩色多普勒超声高频探头可作为筛查诊断和鉴别儿童及青少年甲状腺良恶性肿瘤的首选检查技术。

Purpose： The purpose of this study is to improve the diagnostic level based on the understanding of clinical symptoms and ultrasonographic features of thyroid carcinoma in childhood and teenagers. Meth- ods： One hundred and forty-one cases of children and teenagers with thyroid nodules from January 2004 to December 2011 were retrospectively analyzed. Regard pathology results as the gold standard, a logistic regres- sion model of ultrasonographic features of the tumor was established to predict children and teenagers thyroid cancer. Results： Of all the 141 cases of children thyroid carcinoma, 62 cases were thyroid cancers, while 79 cases of thyroid nodules were benign. Of 9 character features of thyroid carcinoma, 4 were put into the mul- tiple logistic regression model finally. The order from big to small according to the increased relative risk was intranodular vascularization （Type III） （19.607） , irregular outline （10.389）, hypoechoic nodules （6.174）, the presence of microcalcification in nodules （5.529）. Jorden index, which was the combined index, showed that irregular shape plus increased intranodular vascularization in tumor type I]I flow had the strongest abil- ity of screening thyroid cancer in children and teenagers. Conclusion： Color Doppler ultrasound with high frequency probe can be used as a preferred inspection technology to diagnosis and differential diagnosis of benign and malignant thyroid tumors in children and teenagers.