恶性甲状腺结节的超声特点和鉴别因素

Monographic Features and Differential Diagnosis of Malignant Thyroid Nodules

目的分析甲状腺恶性结节的超声特点,探讨鉴别甲状腺恶性结节的超声表现因素。方法回顾性分析2009年到2014年超声检查发现的1 226例甲状腺结节,以术后病理结果为金标准,观察比较良恶性结节的结节数目、前后径与横径比(AP/TR)、边缘、钙化类型、性质、回声、结节内及结节周边血流等超声特点。结果甲状腺恶性结节中,单发结节、AP/TR≥1、低回声、微小钙化、边缘不规整、结节内少或富含血流等超声影像特点的发生率明显高于良性结节(P<0.05)。单因素分析显示若结节为单发结节、AP/TR≥1、实性结节、边缘不规整、低回声、微小钙化、结节内少或富含血流时,则恶性结节发生的风险明显升高(P<0.05);多因素回归分析法显示AP/TR≥l、实性结节、边缘不规整、低回声、微小钙化为恶性结节独立危险因素(P<0.05),低回声(P=0.016,OR=7.685)、微小钙化(P=0.005,OR=7.515)具有很强的预测作用。结论超声对甲状腺恶性结节的鉴别诊断有重要意义,综合分析甲状腺恶性结节的超声特点可提高对其鉴别诊断的准确率。

Objective To study the monographic features and differential diagnosis of malignant thyroid nodules.Meth-ods The monographic and pathological data of 1 226 thyroid nodules were studied,fine needle aspiration and/or thyroidectomy were performed.Results Microcalcification,blurred nodular margin,AP/TR≥1（antero-posterior and transversal diameters）,sol-itary,and hypoechoic appearance were more common in malignant nodules than in benign nodules （P〈0.05）.Logistic regression analysis showed that microcalcification,blurred nodular margin,AP/TR≥1,solid and hypoechoic appearance were independent factors of malignancy under ultrasound examination of thyroid nodules （P〈0.05）.Conclusion Ultrasound findings are of high diagnostic value for malignant thyroid nodules,and integrated image features can improve the differential diagnosis accuracy.