甲状腺癌与甲状腺瘤的超声表现特征及临床意义

Ultrasound features of thyroid cancer and thyrophyma and its clinical significance

目的探讨甲状腺癌与甲状腺瘤的超声表现特征及临床诊疗意义。方法选取2017年1月至2019年12月间上海市第一人民医院宝山分院收治的40例甲状腺癌患者和40例甲状腺瘤患者,均行彩色多普勒超声诊断,比较两组患者的超声诊断准确性、图像特征、血流动力学特征[血流分级、动脉收缩期峰值流速(PSV)和阻力指数(RI)]和超声弹性应变率(SR)比值。结果甲状腺癌患者中,乳头状癌24例(60.0%),滤泡状癌12例(30.0%),未分化癌2例(5.0%),髓样癌2例(5.0%);甲状腺癌伴发结节性甲状腺肿21例(52.5%),微钙化23例(57.5%)。甲状腺瘤伴粗大钙化17例(42.5%)。与病理学结果比较,甲状腺癌超声诊断准确率为87.5%(35/40),低于甲状腺瘤的95.0%(38/40),但差异无统计学意义(P>0.05)。甲状腺癌误诊率为7.5%(3/40),漏诊率为5.0%(2/40),甲状腺瘤误诊率为5.0%(2/40)。甲状腺癌超声图像表现为结节形态不规则、结节边界不清晰、回声不均匀及内部血流丰富等。甲状腺瘤超声图像表现为结节形态规则、结节边界清晰、回声均匀和血流不丰富等。两组患者结节数量、形态、边界、内部回声和后方回声比较,差异均有统计学意义(均P<0.05)。甲状腺癌血流分级中2级和3级最多,甲状腺瘤血流分级中0级和1级最多,两组比较,差异有统计学意义(P<0.05)。甲状腺癌的PSV、RI和SR比值均较甲状腺瘤高,差异均有统计学意义(均P<0.05)。结论彩色多普勒超声诊断甲状腺癌和甲状腺瘤的准确性均较高,并可根据甲状腺结节数量、形态、边界、回声和血流等较为准确鉴别甲状腺癌和甲状腺瘤。

Objective To analyze the of ultrasound characteristics of thyroid cancer and thyrophyma and its clinical significance.Methods A total of 40 patients with thyroid cancer and 40 patients with thyrophyma who were treated at Shanghai First People’s Hospital Baoshan Campus were enrolled in the present study from January 2017 to December 2019.All patients underwent color Doppler ultrasound.The accuracy,image characteristics,hemodynamic characteristics including peak systolic velocity(PSV)and resistive index(RI)and strain rate(SR)of ultrasound diagnosis were compared between the two groups.Results Of the patients with thyroid cancer,24(60.0%)patients had papillary carcinoma,12(30.0%)had follicular carcinoma,2(5.0%)had undifferentiated carcinoma and 2(5.0%)had medullary thyroid carcinoma.Twenty-one(52.5%)patients had thyroid cancer complicated with nodular goiter,23(57.5%)had micro-calcification and 17(42.5%)had thyrophyma complicated with macrocalcification.Compared with pathological results,the accuracy of ultrasound diagnosis for thyroid cancer was 87.5%(35/40)which was lower than 95.0%(95/40)for thyrophyma,but the difference was not statistically significant(P>0.05).The misdiagnosis rate of thyroid cancer was 7.5%(3/40),the rate of missed diagnosis was 5.0%(2/40),and the misdiagnosis rate of thyrophyma was 5.0%(2/40).Ultrasound images of thyroid cancer showed irregular morphology of nodules,unclear boundary of nodules,uneven echo,and abundant internal blood flow.Ultrasound images of thyrophyma showed regular nodule morphology,clear nodule boundary,uniform echo,and lack of blood flow.There were significant differences in the number of nodules,nodule morphology,nodule boundary,internal echo,and posterior echo between the two groups(all P<0.05).In terms of blood flow classification of thyroid cancer,grades 2 and 3 were the highest.For thyrophyma,grade 0 and grade 1 were the highest(all P<0.05).PSV,RI and SR ratios were higher for thyroid cancer than for thyrophyma(all P<0.05).Conclusion The accuracy of color Doppler ultrasound is high in the diagnosis of thyroid cancer and thyrophyma.It can distinguish thyroid cancer and thyrophyma according to the number,shape,boundary,echo and blood flow of thyroid nodules.