超声对桥本甲状腺炎甲状腺微小乳头状癌的诊断价值

The value of ultrasonography in the diagnosis of papillary thyroid microcarcinoma with Hashimoto's thyroiditis

目的探讨超声对桥本甲状腺炎(HT)甲状腺微小乳头状癌(PTMC)的诊断价值。方法回顾性分析2012年11月至2013年12月上海交通大学医学院附属瑞金医院107例HT患者111个甲状腺微小结节的超声表现特征,包括结节的纵横比、形态、边界、边缘、声晕、内部结构、回声水平、微钙化、后方声衰减、血管模式及血供程度以及甲状腺实质回声。采用χ2检验及Fisher确切概率法比较HT合并甲状腺良性结节患者与HT合并PTMC患者甲状腺微小结节超声特征差异。以手术后病理结果作为金标准,计算超声诊断HT合并PTMC的敏感度、特异度、准确性、阳性预测值、阴性预测值。结果 107例HT患者111个甲状腺微小结节术后病理证实75个为PTMC,36个为良性。111个甲状腺微小结节均表现为实性低回声。PTMC与甲状腺微小良性结节边缘、微钙化、血管模式及血供程度差异有统计学意义(χ2=5.79,P=0.02;χ2=9.08,P=0.00;χ2=9.40,P=0.00;χ2=6.12,P=0.02);纵横比、形态、边界、声晕、后方声衰减、甲状腺实质回声差异均无统计学意义。超声诊断HT合并PTMC的敏感度为93.33%(70/75),特异度为36.11%(13/36),准确性为74.77%(83/111),阳性预测值为75.27%(70/93),阴性预测值为72.22%(13/18)。结论 HT患者PTMC的部分典型恶性特征不明显,超声具有一定的诊断价值。

Objective To investigate the value of ultrasonography in the diagnosis of the papillary thyroid microcarcinoma （PTMC） in patients with Hashimoto’s thyroiditis （HT）.MethodsThis retrospective study used data from Ruijin Hospital of Shanghai Jiaotong University of Medicine during November 2012 to December 2013. A total of 111 small thyroid nodules （75 PTMC/36 benign nodules） with 107 HT cases which were pathologically conifrmed were included in this study. The sonographic characteristics of nodules were investigated, including nodule aspect ratio, shape, border, margin, acoustic halo, internal structure, echo level, microcalciifcations, rear acoustic attenuation, vascular pattern and extent of the blood supply and the types of thyroid tissue echogenicity. Chi-square test and Fisher′s exact probability method was used to compare the differences of the sonographic characteristics between the benign nodules and malignant nodules. With surgical pathology as the gold standard, computing the value of ultrasonography in the diagnosis of PTMC with HT, including the sensitivity, speciifcity, diagnostic accuracy, positive predictive value and negative predictive value.ResultsA total of 111 thyroid tiny nodules （75 PTMC/36 benign nodules） with 107 HT cases which were pathologically conifrmed were included in this study. The results showed 111 small thyroid nodules as solid hypoechoic. Four indexes between PTMC and benign nodules had statistical signiifcance, such as margin, microcalciifcations, vascular pattern and extent of the blood supply. The other six indexes between PTMC and benign nodules had no statistical significance, such as aspect ratio, shape, border, acoustic halo, rear acoustic attenuation and the types of thyroid tissue echogenicity. Ultrasound diagnostic accuracy of small tyroid nodules in patients with HT was 74.77% （83/111）. The sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of the ultrasound diagnosis of PTMC were 93.33% （70/75）, 36.11% （13/36）, 74.77% （83/111）, 75.27% （70/93）, and 72.22% （13/18）, respectively.ConclusionsCompared with general population, some classic ultrasound features became less effective in patients with HT. However, ultrasonography has some differential diagnostic value in these cases.