不同特点的钙化与甲状腺钙化性结节良恶关系的探讨

Study on the Relationship between Calcification of Different Characteristics and Benign and Malignant Thyroid Nodules

目的探讨超声在对不同钙化特点的甲状腺钙化性结节的良恶性鉴别诊断中的应用价值。方法回顾性分析265例286枚经超声诊断且在病理下证实的甲状腺钙化性结节患者的资料,根据钙化性结节超声图像上表现的不同钙化特点将其分为Ⅰa类、Ⅰb类、Ⅱa类、Ⅱb类、Ⅲa类和Ⅲb类,在这6类中良性钙化性结节共104枚,恶性钙化性结节共182枚;分析不同特征类型钙化与甲状腺钙化性结节的良、恶性的相关性。结果 286枚甲状腺钙化性结节中,104枚良性钙化性结节,182枚恶性钙化性结节,恶性及良性钙化性结节分别占63.6%(182/286)、36.4%(104/286),Ⅰa类、Ⅱb类钙化在二者之间具有显著统计学差异(P<0.01),Ⅰa类钙化更常见于恶性钙化性结节中,Ⅱb类钙化更常见于良性钙化性结节中。Ⅰb类、Ⅱa类、Ⅲa类和Ⅲb类钙化在两者之间无统计学意义(P>0.05)。结论超声诊断的甲状腺钙化性结节中不同的钙化特点对甲状腺钙化性结节的良、恶性的提示意义各不相同,微钙化a特征对甲状腺恶性钙化性结节的诊断有帮助,粗大钙化b特征对甲状腺良性钙化性结节的诊断有帮助。难以单凭微钙化b特征(Ⅰb)、粗大钙化a特征(Ⅱa)及周边钙化(Ⅲa、Ⅲb)对甲状腺钙化性结节的良恶性做出判断。

Objective To explore the value of ultrasound in the differential diagnosis of benign and malignant thyroid calcification nodules with different calcification characteristics. Methods 265 patients with 286 of thyroid calcified nodules diagnosed by ultrasonography and confirmed by pathology were retrospectively analyzed. According to the different calcification characteristics of calcified nodule ultrasound images, The 286 cases of thyroid calcified nodules were divided into three classes and two different types in each class as designated □a, □b, □a, □b, □a, and □b, among which, there were 104 benign calcification nodules and 182 malignant calcification nodules. Analysis was performed to assess the correlation between different types of thyroid calcification nodules and their pathological features （benign or malignancy）. Rosults The 286 thyroid calcification nodules consist of 104 benign （36.4%） and 182 malignant （63.6%） calcification nodules. Type □a calcification nodules were more common in malignant thyroid calcification nodules, while type □b calcification nodules were often seen in benign thyroid calcification nodules. There were significant difference in Ia, □b between the benign thyroid calcification and the malignant thyroid calcification nodules （P〈0.01）. In contrast, other types of thyroid calcification nodules, including □b, □a, □a and □b, all failed to show any differences between calcification nodule types and nodule pathology （benign or malignancy）（P〉0.05）. Conclusion The different types of calcification of thyroid nodules based on ultrasound have different clinical implications in determination of benign or malignant thyroid nodules.Class □a calcification is helpful in the diagnosis of thyroid malignant calcification nodules, and type □b calcification is helpful in the diagnosis of benign calcified nodules of the thyroid. However, for other types of thyroid calcification nodules, including □b, □a, □a and □b, it is insufficient to only rely on ultrasound diagnosis of calcification types of thyroid nodules in determination of the benign and malignant.