钙化与甲状腺癌关系的再认识

Recognizing the relationship between calcification and thyroid cancer

目的探讨不同类型钙化对甲状腺良恶性结节的鉴别诊断价值。方法 2013年1至10月在华中科技大学同济医学院附属同济医院行甲状腺超声检查的195例患者共258个结节。重点观察甲状腺结节数目、回声以及结节内钙化灶的大小、形态和分布,将不同钙化模式分为3型:Ⅰ型微小点状微钙化,Ⅱ型粗大钙化,Ⅲ型周边钙化。结果甲状腺恶性结节钙化率为68.6%(81/118),高于甲状腺良性结节钙化率40.0%(56/140),且差异有统计学意义(χ2=21.096,P<0.01)。Ⅰ型微小点状微钙化在甲状腺恶性结节中的发生率为72.8%(59/81),高于其在甲状腺良性结节中的发生率41.1%(23/56),且差异有统计学意义(χ2=13.906,P<0.01)。Ⅱ型粗钙化在甲状腺良恶性结节中的发生率差异无统计学意义[23.5%(19/81)vs 37.5%(21/56),χ2=3.159,P>0.05]。Ⅲ型周边钙化在甲状腺良性结节中的发生率为21.4%(12/56),高于其在甲状腺恶性结节中的发生率3.7%(3/81),且差异有统计学意义(χ2=10.669,P<0.05)。伴钙化的甲状腺单发结节、甲状腺极低回声结节恶变率分别为85.3%(58/68)、76.2%(48/63),均高于伴钙化的甲状腺多发结节、甲状腺其他回声结节恶变率33.3%(23/69)、44.6%(33/74),且差异均有统计学意义(χ2=38.261、14.057,均P<0.01)。结论甲状腺结节内每种钙化都存在恶性风险,不同类型钙化对于甲状腺良恶性结节的鉴别具有重要价值。

Objective To investigate the differential diagnostic significance of different calcification types in thyroid benign and malignant nodules with high-frequency ultrasound. Methods Totally 195 patients with thyroid lesions were examined on conventional high-frequency ultrasound pre-operatively. The evaluation was foucsed on the number and echo of thyroid nodules and the size, shape and distribution of calcification inside. Different calcification patterns were divided into 3 types： type 1 micro-calcification, type 2 coarse calcification, type 3 peripheral calcification. Results The calcification rate of thyroid malignant nodules 68.6% （81/118） was significantly higher than that of benign nodules 40.0% （56/140） （Z2=21.096, P 〈 0.01 ）. The ratio of type 1 calcification in malignant nodules 72.8% （59/81） was obviously higher than that of benign nodules 41.1% （23/56） 0（2=13.906, P 〈 0.01 ）. There was no significant difference of type 2 calcification between malignant and benign nodules （3（2=3.159, P 〉 0.05）. The incidence of type 3 calcification in malignant lesions 3.7% （3/81） was lower than that of benign nodules 21.4% （12/56） （Z2=10.669, P 〈 0.05）. The malignancy incidence of solitary thyroid nodule 85.3% （58/68） and extremely low echo nodules with calcification 76.2% （48/63） was higher than that of multiple thyroid nodules 33.3% （23/69） and other echo nodules 44.6% （33/74） （k~=38.261, 14.057, both P〈0.01）. Conclusions There was potential risk of malignancy in each calcification of thyroid nodules. Different calcification types had important value for differential diagnosis of benign and malignant thyroid nodules.