超声检查误诊为甲状腺癌的甲状腺良性结节超声声像图及病理特征分析

Analysis of Echogram and Pathological Characteristics of Benign Thyroid Nodules Misdiagnosed as Thyroid Carcinoma by Ultrasonography

目的探讨超声检查误诊为甲状腺癌的甲状腺良性结节超声声像图及病理特征。方法对2012—2015年重庆三峡中心医院超声科超声检查误诊为甲状腺癌的甲状腺良性结节70例(86个结节)的术前超声及术后病理学检查资料进行回顾性分析。结果 86个超声检查误诊的甲状腺良性结节中,术前超声声像图主要表现为极低回声(80.23%)、不规则边缘(58.14%)、纵横径比≤1(69.77%)、钙化(77.91%)、囊实性(86.05%)、结节>10 mm(52.33%),TIRADS分类主要为4a^4c类(88.37%)。术后病理学检查诊断结节性甲状腺肿62例(88.57%),甲状腺非典型腺瘤6例(8.57%),亚急性甲状腺炎2例(2.86%);病理学特征主要表现为广泛纤维化伴玻璃样变72个(83.72%),钙化57个(66.28%),含铁血黄素19个(22.09%),浓缩胶质13个(15.12%),炎性细胞浸润7个(8.14%),骨化生3个(3.49%),陈旧性出血及上皮鳞状化生各2个(2.33%)。结论病理学特征表现为玻璃样变、钙化的甲状腺良性结节超声检查易误诊为恶性结节,临床应结合病理学及其他检查方法进行综合诊断。

Objective To investigate ultrasound echogram and pathologic characteristics of benign thyroid nodules misdiagnosed as thyroid carcinoma by ultrasonography. Methods Clinical data of preoperative ultrasound echogram and postoperative pathologic examination of 70 patients（ 86 nodules） with benign thyroid nodules misdiagnosed as having thyroid carcinoma by ultrasonography from 2012 to 2015 was retrospectively analyzed. Results Among the 86 misdiagnosed nodules,preoperative ultrasonographic characteristics were very low echo-level（ 80. 23%）,irregularity edge（ 58. 14%）,vertical and horizontal diameter ratio less than or equal to 1（ 69. 77%）,calcification（ 77. 91%）,cystic and solid（ 86. 05%）,nodule diameter more than 10 mm（ 52. 33%） and main TIRADS classification with 4a-4c（ 88. 37%）. Postoperative pathological examination showed nodular goiter in 62 cases（ 88. 57%）,atypical adenoma of thyroid gland in 6 cases（ 8. 57%） and subacute thyroiditis in 2 cases（ 2. 86%）. Mainly pathological characteristics were extensive fibrosis associated by vitreous degeneration in 72 cases（ 83. 72%）,calcification in 57 cases（ 66. 28%）,hemosiderin in 19 cases（ 22. 09%）,enriched gloea in 13 cases（ 15. 12%）,inflammatory cells infiltration in 7 cases（ 8. 14%）,osseous metaplasia in 3 cases（ 3. 49%）,remote hemorrhage in 2 cases（ 2. 33%） and epithelial squamous metaplasia in 2 cases（ 2. 33%）. Conclusion Vitreous degeneration and calcification of pathological characteristics in patients with benign thyroid nodules are easily misdiagnosed as having malignant thyroid nodules by ultrasound examination,and therefore clinicians should comprehensively diagnose combined with pathological and other examinations.