常规超声联合超声造影诊断甲状腺微小乳头状癌的价值

Diagnostic value of conventional ultrasound combined with contrast-enhanced ultrasound for papillary thyroid microcarcinoma

目的评价常规超声、超声造影及常规超声联合超声造影诊断甲状腺微小乳头状癌的临床价值。方法选取2013年6月-2015年6月在解放军总医院接受甲状腺常规超声及超声造影检查的161例患者(共175个结节,最大径≤1 cm),男性29例,女性132例,平均年龄为(46.2±15.2)岁。经病理证实恶性结节89个,均为乳头状癌,良性结节86个,病理类型分别为结节性甲状腺肿(57个)、甲状腺腺瘤(16个)、桥本甲状腺炎(10个)、亚急性甲状腺炎(3个)。评价常规超声联合超声造影诊断甲状腺微小乳头状癌的灵敏度、特异度及准确度。结果甲状腺微小乳头状癌超声造影多表现为低增强且晚于周围甲状腺实质增强,与甲状腺良性结节相比,两者增强时间和增强程度差异有统计学意义(P<0.01)。根据超声造影特点诊断甲状腺微小结节良恶性的灵敏度、特异度及准确度分别为89.9%(80/89)、91.9%(79/86)、90.9%(159/175);根据甲状腺微小结节的形态、内部回声、钙化、边界、纵横比、血流等常规超声特点诊断结节良恶性的灵敏度、特异度及准确度分别为86.5%(77/89)、87.2%(75/86)、88.9%(152/175);常规超声联合超声造影诊断甲状腺微小乳头状癌的灵敏度、特异度及准确度分别为94.4%(84/89)、93.0%(80/86)、93.7%(164/175)。结论高频超声可作为鉴别甲状腺微小结节良恶性的首选方法,但对部分特征不典型的微小结节,超声造影可作为重要补充手段,高频超声联合超声造影可提高甲状腺结节的诊断准确率。

Objective To evaluate the diagnostic value of conventional ultrasound（US）, contrast-enhanced ultrasound（CEUS） and conventional US combined with CEUS for papillary thyroid microcarcinoma. Methods From June 2013 to June 2015, thyroid ultrasound examination was performed to 161 patients with 175 thyroid nodules（≤1 cm） in Chinese PLA General Hospital. Of the 161 cases, there was 29 males and 132 females with average age of（46.2±15.2） years. Of the 175 nodules, 89 nodules were pathologically proved to be malignant and 86 nodules were benign. Pathological type of benign lesions included nodular goiter（n=57）, thyroid adenoma（n=16）, hashimoto thyroiditis（n=10）, subacute thyroiditis（n=3） and all the malignant lesions were papillary thyroid microcarcinoma. Sensitivity, specificity and accuracy of conventional US, CEUS and their combination were calculated to evaluate their diagnostic values. Results Compared with benign thyroid nodules, the intensity of enhancement of CEUS imaging of papillary thyroid carcinoma was lower and later than the surrounding thyroid parenchyma enhancement（P〈0.01）. The sensitivity, specificity and accuracy of contrast enhanced ultrasound to diagnose malignant nodules were 89.9%（80/89）, 91.9%（79/86）, 90.9%（159/175） respectively, and they were 86.5%（77/89）, 87.2%（75/86） and 88.9%（152/175） by conventional US, according to the characteristic of morphology, internal echo, calcification, boundary, aspect ratio, and blood flow of thyroid nodules. The sensitivity, specificity and accuracy of conventional US combined with CEUS were 94.4%（84/89）, 93.0%（80/86）, 93.7%（164/175）, respectively. Conclusion Conventional ultrasound can be used as the first choice for distinguishing benign and malignant thyroid nodules, but for some atypical nodules, CEUS can be used as an important assisted method. Conventional ultrasound combined with contrast-enhanced ultrasound can improve the diagnostic accuracy for dignosis of thyroid nodules.