超声在甲状腺微小乳头状癌与微小结节性甲状腺肿鉴别诊断中的价值

Ultrasound′s value on differential diagnosis of papillary thyroid microcarcinoma and small nodular goiter

目的评价超声对甲状腺微小乳头状癌与微小结节性甲状腺肿的鉴别诊断价值。方法病例选自2010年8月~2013年7月本院收治的50例甲状腺微小结节患者,经术后病理结果证实,微小乳头状癌28例（结节32个）为观察组,微小结节性甲状腺肿22例（结节25个）为对照组,对比分析两组患者的超声诊断资料,评价超声对两组的鉴别诊断价值。结果观察患者回声情况（低回声/高回声）、形态（规则/不规则）、边界（清晰/模糊）及钙化状况（边缘钙化/微钙化/粗钙化）与对照组比较,差异均有统计学意义（P〈0.05）;观察组的动脉收缩期峰值速度（Vmax）及阻力指数（RI）均显著高于对照组（P〈0.05）;彩色多普勒检查结果显示,观察组血流丰富程度明显高于对照组（P〈0.05）,分型为Ⅱ型的患者比例显著高于对照组（P〈0.01）。结论超声对甲状腺微小乳头状癌及微小结节性甲状腺肿具有良好的鉴别诊断价值,临床上应仔细辨别两种疾病的声像特点,以免漏诊、误诊。

Objective To evaluate the differential diagnosis value of ultrasound on papillary thyroid microcarcinoma and small nodular goiter. Methods From August 2010 to July 2013,50 patients with small nodules in thyroid were selected.After confirmation from postoperative pathological results,papillary microcarcinoma in 28 cases with 32 nodules was categorized into the observation group,and small nodular goiter in 22 cases with 25 nodules was classified into the control group.Data from ultrasonic diagnosis in the two groups were compared and analyzed in order to evaluate differential diagnosis value of ultrasound. Results Hypoecho or hyperecho,regular or irregular shape,clear or vague boundary,and calcification dividing into margin calcification,microcalcification and coarse calcification in the observation group displayed statistical differences in comparison with those in the control group（P〈0.05）.In the observation group,maximal velocity（Vmax） during arterial systole and resistance index（RI） were both higher than those in the control group.The difference after comparisons both displayed statistical significance（P 0.05）.Outcomes from color Doppler ultrasonography in the two groups indicated that blood flow abundance in the observation group was remarkably higher than that in the control group（P〈0.05）.Among different classifications of papillary thyroid microcarcinoma,proportion of patients in type Ⅱ was higher in comparison with that in the control group（P〈0.01）. Conclusion Ultrasound has a favorable value on differential diagnosis of papillary thyroid microcarcinoma and small nodular goiter.The characteristics of sound image of the two kinds of diseases should be clearly differentiated in clinic in order to avoid missed diagnosis or misdiagnose.