甲状腺皱缩结节的超声分型及其演变

Ultrasonic classification and evolution of thyroid shrinking nodules

目的探讨甲状腺皱缩结节的常规超声表现和演变,以改善其鉴别诊断和管理策略,尽可能避免不必要的活检。方法选取2015年5月至2020年7月于上海交通大学医学院附属第一人民医院南部院区就诊且经细针穿刺细胞学检查(fine needle aspiration cytology,FNAC)证实为甲状腺良性结节陈旧性出血患者245例,共计263枚结节。回顾性分析结节的大小、形态、纵横比、回声、边缘、边界、周边、声晕、钙化、后方回声增强、后方回声衰减等声像图参数,将其进行超声分型;选择其中具有两次以上完整超声随访资料的40例患者的41枚结节,对比上述参数的变化,探讨结节演变。结果263枚甲状腺皱缩结节分为4种类型:"囊壁萎缩征"型(71.48%,188/263)、"类癌"型(22.05%,58/263)、"类炎症"型(3.04%,8/263)和"不明确非典型实性结节"型(3.42%,9/263)。连续随访的41枚结节中,37枚观察到明显的囊壁萎缩征,其中13枚"囊壁萎缩征"型又继续演变为"类癌"型7例和"类炎症"型6例。结论甲状腺皱缩结节超声表现是一个动态变化的过程,可分为"囊壁萎缩征"型、"类癌"型、"类炎症"型和"不明确非典型实性结节"型4个类型。"囊壁萎缩征"型是甲状腺皱缩结节典型和常见的超声表现类型。"囊壁萎缩征"型可以向"类癌"型和"类炎症"型单向转化演变。

Objective To investigate the ultrasonographic features and evolution of thyroid shrinking nodules in order to improve the differential diagnosis and management strategy and avoid unnecessary biopsy.Methods A total of 245 patients with old bleeding of benign thyroid nodules diagnosed via fine needle aspiration cytology(FNAC)from May 2015 to July 2020 in the southern part of the Shanghai General Hospital Affiliated to the Medical College of Shanghai Jiaotong University,including 263 nodules.The sonographic parameters such as size,shape,aspect ratio,echo,edge,boundary,periphery,halo,calcification,posterior echo enhancement and posterior acoustic attenuation of nodules were analyzed retrospectively,and the ultrasonic appearances of nodules were classified;41 nodules from 40 patients,who did ultrasound examinations more than twice and had both complete ultrasonographic data,were compared and then classified in order to explore the evolution rules of the nodules.Results Two hundred and sixty-three thyroid shrinking nodules in 245 cases were classified into 4 types:"cystic wall shrinkage sign"type(71.48%,188/263),"carcinoma-like"type(22.05%,58/263),"inflammation-like"type(3.04%,8/263)and"undefined atypical solid nodules"type(3.42%,9/263).Of the 41 consecutive follow-up nodules,37 cases showed obvious cystic wall shrinkage sign,and 7 of them developed into"carcinoma-like"type and 6 cases into"inflammation-like"type.Conclusions The ultrasonographic appearance of thyroid shrinking nodules is a dynamic process,which can be divided into 4 types:"cystic wall shrinkage sign","carcinoma-like","inflammation-like"and"undefined atypical solid nodules"types.The"cystic wall shrinkage sign"type is typical and common.The"cystic wall shrinkage sign"type can develope into the"carcinoma-like"type or the"inflammation-like"type.