超声钙化征象在桥本甲状腺炎背景下甲状腺乳头状癌鉴别诊断中的价值

Value of ultrasonic calcifications in differential diagnosis of thyroid papillary carcinoma in Hashimoto＆#39;s thyroiditis background

目的 研究超声钙化征象对桥本甲状腺炎背景下甲状腺乳头状癌鉴别诊断中的临床价值,为临床诊疗提供依据.方法 回顾分析经病理检查的800例甲状腺结节患者的临床资料,患者均行超声检查,伴桥本甲状腺炎者180例纳入观察组,无桥本甲状腺炎者620例纳入对照组,以病理检查结果为判断标准,比较超声检查钙化征象对桥本甲状腺炎和甲状腺乳头状癌的鉴别诊断价值.结果 观察组结节平均直径为（10.78±2.16）mm,对照组结节平均直径为（11.98±3.25）mm,两组差异无统计学意义（t=2.153,P=0.083）;观察组超声鉴别甲状腺结节良性和甲状腺乳头状癌的准确率为76.67％（138/180）,对照组鉴别甲状腺结节良性和甲状腺乳头状癌的准确率为80.81％（501/620）,两组差异无统计学意义（χ2=0.898,P=0.098）;两组恶性结节的粗钙化率和微钙化率比较差异无统计学意义（χ2=0.558,P=0.175）.观察组恶性结节微钙化率为53.13％,显著高于良性结节的12.07％（χ2=32.142,P=0.001）;对照组恶性结节微钙化率、粗钙化率分别为49.28％、12.08％,均高于良性结节的19.13％、6.05％,差异均有统计学意义（χ2=67.368、7.056,P=0.001、0.009）;观察组良性结节、恶性结节粗钙化率分别为6.25％、11.21％,两者差异无统计学意义（χ2=1.098,P=0.062）.结论 是否合并桥本甲状腺炎对甲状腺乳头状癌的超声鉴别诊断无影响,微钙化较多发生于恶性结节,但是无桥本甲状腺炎背景时粗钙化也可出现于恶性结节.

Objective To study the clinical value of ultrasonic calcifications in differential diagnosis of thyroid papillary carcinoma in Hashimoto＇s thyroiditis background,to provide basis for clinical diagnosis and treatment.Methods The clinical data of 800 patientss with thyroid nodules who were examined by pathological examination were retrospectively analyzed.All patients underwent ultrasound examination,180 cases with Hashimoto＆#39;＆#39;s thyroiditis were included in the study group,620 cases without Hashimoto＆#39;＆#39;s thyroiditis were included in the control group.The gold standard was the result of pathology.The value of ultrasonography and calcifications for the identification of Hashimoto＆#39;＆#39;s thyroiditis and thyroid papillary carcinoma was compared.Results The average diameter of the study group was （10.78±2.16）mm,which of the control group was （11.98±3.25）mm,there was no significant difference（t=2.153,P=0.083）.The accurate rate of ultrasound in the differential diagnosis of benign thyroid nodules and papillary thyroid carcinoma in the study group was 76.67%（138/180）,which in the control group was 80.81%（501/620）,the difference was not statistically significant（χ2=0.898,P=0.098）.There was no significant difference in coarse calcification rate and micro calcification rate of malignant nodules between the two groups（χ2=0.558,P=0.175）.In the study group,the rate of micro calcification in malignant nodules was 12.07%,which was significantly higher than 53.13% in benign nodules（χ2=32.142,P=0.001）.In the control group,the micro calcification rate and coarse calcification rate of malignant nodules were 49.28% and 12.08%,respectively,which were higher than 19.13% and 6.05% of benign nodules （χ2=67.368,7.056,P=0.001,0.009）.The coarse calcification rate of benign nodules and malignant nodules in the study group were 6.25% and 11.21%,respectively,there was no significant difference（χ2=1.098,P=0.062）.Conclusion Whether associated with Hashimoto＇s thyroiditis has no influence in the ultrasound differential diagnosis of thyroid papillary carcinoma,more micro calcification occurs in malignant nodules,but without the background of Hashimoto＇s thyroiditis,coarse calcification can also be seen in malignant nodules.