不同钙化类型及不同大小甲状腺结节良恶性的鉴别诊断

Differential diagnosis of benign and malignant thyroid nodules of different calcification types and sizes

目的探讨超声对伴有不同钙化类型、不同大小的甲状腺结节良恶性的鉴别诊断效能。方法纳入2014年1月~2014年9月来我院行甲状腺超声检查的患者848例,共893个伴有钙化的甲状腺结节。893个结节中,390个结节直径≤1cm,503个结节直径>1cm。钙化的类型分类有数个微钙化、1个微钙化、粗钙化、周边弧形和环状钙化。根据结节大小分成小结节组(≤1cm)和大结节组(>1cm),比较两组间良恶性差异。结果在小结节组,恶性比例最高的是伴有数个微钙化的结节,其次是伴有1个微钙化的结节,再次是结节内粗钙化,周边弧形钙化和环状钙化恶性。数个微钙化与结节内粗钙化、周边环形钙化和周边弧形钙化差异均有统计学意义(P<0.05)。1个微钙化与结节内粗钙化、周边环形钙化和周边弧形钙化差异均有统计学意义(P<0.05)。在大结节组,伴有数个微钙化的结节恶性风险远远高于伴有其他类型钙化的结节(P<0.05);伴有1个微钙化的结节恶性风险高于伴有结节内粗钙化的结节(P<0.05);其余钙化类型恶性风险差异无统计学意义(P>0.05)。不同钙化类型在大、小结节组恶性风险不尽相同。伴有1个微钙化和结节内粗钙化在小结节组的恶性风险明显高于大结节组(P<0.05),1个微钙化和粗钙化在两组鉴别诊断良恶性时差异有统计学意义(P<0.05)。结论伴有任何钙化类型的结节恶性风险均会增高,其中伴有数个微钙化的结节恶性风险最高。直径≤1cm的伴有钙化的结节恶性风险高于直径>1cm的结节,伴有1个微钙化和粗钙化直径≤1cm的结节恶性风险更高,临床工作中,需综合考虑。

Objective To evaluate the positive predictive value in different size of thyroid nodules with different patterns of calcification by using ultrasonography.Methods 893 calcified nodules were included.Of the 893 nodules,390 nodules were≤ 1 cm and 503 were>1 cm.The types of calcifications were defined as follows: several micro-calcifications,one micro-calcification,coarse calcification,crescent-like and eggshell calcification.They were divided into two groups based on the size.Positive predictive value was calculated.Results The malignancy risks of types calcification several micro-calcifications,one micro-calcification,coarse crescent-like and eggshell calcification in micro group were 82.5%,73.7%,51.1%,46.2% and 33.3%,whereas they were 85.3%,51.6%,22.3%,38.9% and 30% in macro group.The difference between one micro-calcification and coarse calcification were statically significant.Conclusion Micro-nodules,especially with one micro-calcification and coarse calcification patterns,were higher risk of malignancy than macro-nodules.