超声诊断伴周边环形钙化甲状腺结节良恶性的价值

Value of sonographic diagnosis of benign and malignant thyroid nodules with rimlike peripheral calcification

目的探讨超声对伴周边环形钙化良恶性甲状腺结节的鉴别诊断价值。方法回顾分析经手术病理确诊的73例伴周边环形钙化甲状腺结节的超声声像图特征,分析良恶性甲状腺结节的声像图特点,并进行统计学分析。计算各声像图特征对伴周边环形钙化良恶性甲状腺结节的鉴别诊断效能。结果 73例患者中,良性甲状腺结节58例(58/73,79.45%),恶性甲状腺结节15例(15/73,20.55%)。良、恶性结节的平均最大径、边界和内部回声、钙化周围有无声晕差异均无统计学意义(P均>0.05)。良恶性结节伴结节性甲状腺肿的构成比差异、钙化厚薄是否均匀和钙化的连续性差异有统计学意义(P均<0.05)。以伴结节性甲状腺肿诊断良性甲状腺结节的敏感度、特异度、阳性预测值、阴性预测值分别为77.59%(45/58)、60.00%(9/15)、88.24%(45/51)、40.91%(9/22);钙化厚薄不均诊断恶性甲状腺结节的敏感度、特异度、阳性预测值、阴性预测值分别为53.33%(8/15)、87.93%(51/58)、53.33%(8/15)、87.93%(51/58)。钙化连续中断诊断恶性甲状腺结节的敏感度、特异度、阳性预测值、阴性预测值分别为73.33%(11/15)、68.97%(40/58)、37.93%(11/29)、90.91%(40/44)。结论超声对于伴环形钙化甲状腺结节良恶性判断有一定的价值,钙化厚薄不均、连续性中断对诊断恶性病变价值更高。

Objective To investigate the value of ultrasound in differential diagnosis of benign and malignant thyroid lesions with rimlike peripheral calcification.Methods Seventy-three patients of thyroid nodules with rimlike peripheral calcification were analyzed retrospectively.All cases were confirmed by surgery and pathology.The efficacy of sonographic features on diagnosis of thyroid nodules was analyzed.Results Among 73 patients,58（58/73,79.45%）were benign and 15（15/73,20.55%）were malignant.Among the sonographic features mentioned,the mean size,margin,internal echo and presence of halo showed no significant differences between malignant and benign nodules（all P〉0.05）.Proportion of thyroid nodules coexisting with nodular goiter,irregular thickness and interruption of rimlike peripheral calcification had significant differences between malignant and benign nodules（all P〈0.05）.The sensitivity,specificity,positive predictive value and negative predictive value of coexisting with nodular goiter for diagnosing benign nodules were 77.59%（45/58）,60.00%（9/15）,88.24%（45/51）,40.91%（9/22）,respectively.The sensitivity,specificity,positive predictive value and negative predictive value of irregular thickness for diagnosing malignant nodules were 53.33%（8/15）,87.93%（51/58）,53.33%（8/15）,87.93%（51/58）,respectively.The sensitivity,specificity,positive predictive value and negative predictive value of interruption of rimlike peripheral calcification for diagnosing malignant nodules were 73.33%（11/15）,68.97%（40/58）,37.93%（11/29）,90.91%（40/44）,respectively.Conclusion Ultrasonography is helpful to diagnosis of thyroid nodules with rimlike peripheral calcification.Irregular thickness and interruption of calcification are associated with malignancy.