超声检查在甲状腺囊实性结节随访中的应用价值

Diagnostic value of ultrasound of in follow-up of post-absorption changes of cystic-solid nodules

目的探讨超声检查在甲状腺囊实性结节随访中的应用价值。方法回顾性分析2017年11月至2019年6月在上海瑞金康复医院接受超声检查的甲状腺囊实性结节患者79例,所有结节均经细胞学病理检查证实为良性结节。其中74例选择化学消融+物理消融治疗、1例药物治疗、4例自行吸收。所有患者均进行超声随访,随访主要观察囊实性结节吸收后的大小、形态、边界、内部回声、钙化及血流信号等特征,记录结节体积,并与吸收前进行对比分析。结果79例甲状腺囊实性结节在超声随访过程中均表现为不同程度吸收,结节吸收均在同一部位表现为低或极低回声结节,囊性成分逐步减少,甚至消失,体积明显减小,末次随访缩小后平均体积与首次超声检查时的平均体积比较[(1.42±1.36)ml vs(40.78±34.01)ml],差异有统计学意义(P=0.02)。结节体积最大缩小率87%,最小缩小率68%,平均缩小率(75±5)%。79例吸收后结节中,74例超声表现具有恶性结节特征,5例不具有恶性结节特征。结论超声随访可动态观察结节变化过程,甲状腺囊实性结节超声随访时常出现恶性结节征象,明确既往囊性或囊实性结节病史可为判定“木乃伊结节”提供重要依据,避免过度诊断及不必要的细胞学检查。

Objective To assess the application value of ultrasound in the follow-up of thyroid cystic-solid nodules.Methods A retrospective analysis was performed 79 patients with cystic-solid nodules of the thyroid capsule who underwent ultrasound examination at Shanghai Ruijin Rehabilitation Hospital from November 2017 to June 2019.All the cystic-solid nodules were confirmed as benign nodules by cytological pathology.Among the patients included,74 were selected for chemical ablation and physical ablation,1 for drug therapy,and 4 for self-absorption.All patients were followed by ultrasound to observe the size,shape,boundary,internal echo,calcification,and blood flow signal characteristics of the nodules after absorption.The nodule size was recorded and compared with that before the absorption.Results The 79 cases of thyroid cystic-solid nodules were characterized by different degrees of absorption in ultrasound follow-up.Nodule absorption occurred in the same area,characterized by low or very low echo nodules.Cystic components decreased gradually,even disappeared,and significantly decreased in volume.The average volume at the last follow-up was significantly smaller than that at the initial examination[(1.42±1.36)ml vs(40.78±34.01)ml,P=0.02].The maximum reduction rate of nodule volume was 87%,the minimum reduction rate was 68%,and the average reduction rate was(75±5)%.Of the 79 nodules after absorption,74 showed sonographic characteristics of malignant nodules and 5 did not.Conclusion Ultrasonic follow-up allows to dynamically observe the nodularity process.Thyroid cystic-solid nodules often show characteristics of malignant nodules during ultrasonic follow-up,and a clear understanding medical history may provide an important basis for determining"mummy nodules"to avoid excessive diagnosis and unnecessary cytological examination.