超声诊断甲状良恶性结节的声像特征及临床价值

Ultrasonic diagnosis of benign and malignant thyroid nodules and its clinical value

目的探讨超声对甲状腺良恶性结节的鉴别诊断价值及声像特征。方法选取2015年1月至12月海口市妇幼保健院经病理学确诊的132例甲状腺结节患者(141个结节)的二维超声资料进行分析,其中良性结节组61个结节,恶性结节组80个结节,对比两组的声像特征,并计算灰阶超声鉴别甲状腺良恶性结节的诊断学效能指标。结果恶性结节与良性结节的灰阶超声形态是否规则、边界是否清楚、包膜完整性、纵横径比、内部回声、钙化灶、后方回声差异均具有统计学意义(X^2=6.024、15.095、18.116、14.046、9.679、36.598、18.351,P=0.014、<0.001、<0.001、<0.001、0.002、<0.001、<0.001);灰阶超声鉴别诊断甲状腺恶性结节与良性结节的敏感度为68.75%,特异度为77.05%,漏诊率为31.25%,误诊率为22.95%。结论灰阶超声作为一种简便的临床手段对甲状腺良恶性结节的鉴别诊断具有一定的临床价值,但其漏诊率和误诊率较高。

Objective To investigate the value of ultrasonography in the differential diagnosis of benign and malignant thyroid nodules and its characteristics.Methods From January to December 2015 in Maternal and Child Health Care Hoapital of Haikou City, one hundred and thirty-two cases of thyroid nodules pathologically confirmed （141 nodules） of two-dimensional ultrasound data were analyzed by pathology as the gold standard, with 61 benign nodules and 80 malignant nodules. The two groups were compared of image features, and calculated the diagnosis of grey ultrasonography in differential diagnosis of thyroid nodules.Results Malignant thyroid nodules and thyroid ultrasound morphology of benign nodules, the boundary is clear, whether the rules of capsule integrity, aspect ratio, internal echo, calcification, rear echo differences were statistically significant （χ2=6.024, 15.095, 18.116, 14.046, 9.679, 36.598, 18.351, P=0.014, 〈0.001, 〈0.001, 〈0.001, 0.002, 〈0.001, 〈0.001）; the sensitivity of contrast-enhanced ultrasound in differential diagnosis of malignant nodules and benign nodules was 68.75%, the specificity was 77.05%, the misdiagnosis rate was 31.25%, and the diagnositic error rate was 22.95%.Conclusion Ultrasonography has certain clinical value in differential diagnosis of thyroid benign and malignant nodules as simple clinical method, but the rate of misdiagnosis and diagnostic error rate is high.