甲状腺微小癌的超声诊断及漏误诊分析

Ultrasonic diagnosis of thyroid microcarcinoma and analysis on reason for its misdiagnosis

目的分析甲状腺微小癌的超声特点及漏误诊原因。方法回顾性分析26例经手术病理证实的甲状腺微小癌的声像图特征,包括病灶的形态、边界、回声强度、是否有微钙化、彩色多普勒血流成像和是否有淋巴结转移等。结果 26例中11例(11/26,42.31%)术前诊断与病理符合,12例(12/26,46.15%)误诊为小腺瘤或良性结节,3例(3/26,11.54%)漏诊。超声检出的23例中21个为实性低回声(21/23,91.30%);19个边界模糊(19/23,82.61%);12个前后径和横径之比≥1(12/23,52.17%);14个探及微钙化(14/23,60.87%);7个彩色多普勒血流成像显示肿瘤周边或内部血流信号(7/23,30.43%),动脉频谱显示3个阻力指数>0.70,4个阻力指数<0.70。结论甲状腺微小癌二维超声显示结节呈低回声或等回声、边界模糊,肿瘤的前后径和横径之比≥1,肿块周边或内部可见微钙化,且彩色多普勒血流成像显示高阻动脉血流信号、颈部中央区可见肿大淋巴结时,应当高度警惕甲状腺微小癌的可能,尤其对多结节病灶,应警惕良恶性并存。

Objective To analyze the ultrasonic teatures ot tnyrolo mlcrocarclnoma ~w~） and the causes of misdiagnosis. Methods The ultrasonic features including shape, margin, echogenecity, microcalcification, vascularity and lymphadenopathy were analyzed retrospectively in 26 pathologically- proven TMC patients. Results In 26 cases, 11 cases were diagnosed correctly before operation （I 1/26, 42.31%）, 12 cases were misdiagnosed （12/26, 46.15%） as adenoma or benign nodule, and 3 cases were missed diagnosed （3/26, 11.54%）. Among the 23 cases detected on ultrasound, 21 cases were solid and hypoechoic （21/23, 91.30%）; 19 cases were ill-defined （19/23, 82.61%）; 12 cases were taller than wide in shape （12/23, 52.17%）; 14 cases had microcalcification （14/23, 60.87%）; 7 cases showed central or peripheral blood flow signals （7/23,30.43%） with arterial resistance index 〉 0.70 in 3 lesions and 〈 0.70 in 4 lesions. Conclusions Several ultrasonographic features are helpful in identification of TMC, including hypo/iso-echogenecity, ill-defined margin, taller-than-wide shape, microcalcification, arterial signals with high resistance index, and abnormal lymphadenopathy. Moreover, for cases with multiple lesions, to the potential co-existence of benign and malignant lesions should be considered.