超声在甲状腺结节手术决策中的作用:北京协和医院11年回顾

Role of Ultrasound in Decision-making of Surgery for Thyroid Nodules:A Retrospective Analysis of Cases of Peking Union Medical College Hospital in Past 11 Years

目的探讨超声在甲状腺结节手术决策中的作用。方法检索北京协和医院2004年1月至2014年12月因甲状腺结节而行手术切除的病例,按10%~15%的比例分别对2004、2006、2008、2010、2012、2014年手术病例进行随机抽样,查阅抽样的门诊及住院病历,记录是否行术前超声检查,超声报告是否给予诊断提示,如提示则与病理结果对照判断提示是否正确。计算术前超声检查比例、超声提示诊断比例、提示诊断正确率和超声诊断正确率。结果 2004年至2014年甲状腺结节手术例数逐年上升,其中恶性结节的比例逐年增高,由2004年的15.65%上升至2014年的69.91%。抽样结果显示,术前超声检查比例范围为80.65%~96.65%;超声提示诊断比例呈逐年上升趋势,范围为46.94%~92.36%;超声提示诊断正确率在78.26%~93.62%范围内;超声诊断正确率呈逐年上升趋势,范围为36.73%~81.40%。结论近年来甲状腺结节和甲状腺癌患者急剧增加,超声诊断水平逐年提高,在甲状腺结节的外科决策中发挥了越来越重要的作用。

Objective To investigate the role of uhrasound in the decision-making of surgery for thyroid nodules. Methods The cases receiving surgical excision of thyroid nodules in Peking Union Medical College Hospital during the period of January 2004 to December 2014 were collected. We randomly sampled 10% - 15% cases from the collections in 2004, 2006, 2008, 2010, 2012 and 2014, and reviewed the outpatient and inpa- tient records of these sampled cases, extracting information about whether preoperative uhrasonography examina- tion was ordered, whether the ultrasound report provided specific diagnostic suggestion, and whether that diagno- sis was correct judging from pathological results. The rates of preoperative uhrasound, ultrasound diagnostic sug- gestion, specific diagnostic suggestion, and correct ultrasound diagnosis were calculated. Results The number of thyroid nodule surgery increased year by year from 2004 to 2014, with the proportion of malignant nodules ris- ing from 15.65% in 2004 to 69.91% in 2014. The rate of preoperative ultrasound ranged from 80.65% to 96. 65%. The rate of ultrasound diagnostic suggestion demonstrated a constantly ascending trend, ranging from 46. 94% to 92. 36%. The rate of specific diagnostic suggestion was in the range of 78.26% - 93.61%, while the rate of correct ultrasound diagnosis grew year by year, from 36.73% to 81.40%. Conclusions The num- bers of patients with thyroid nodules and thyroid cancer have been soaring in the past 11 years. With the improve- ment in its diagnostic capacity, ultrasonography is playing an increasingly important role in the decision-making of surgery for thyroid nodules.