结节粗钙化形态对甲状腺乳头状癌的诊断价值

Diagnostic value of nodule coarse calcification morphology for papillary thyroid carcinoma

目的观察甲状腺乳头状癌(PTC)结节内粗钙化的形态特点,并分析其与甲状腺影像学报告及数据系统(TI-RADS)分类评分的关系及对PTC的诊断价值。方法选取150例甲状腺结节患者为研究对象,均在术前接受甲状腺超声检查。以病理学检查为金标准,根据粗钙化形态分为规则型和不规则型,根据分布方式分为周边型、中央型和混合型,分析不同形态和分布形式对PTC的诊断价值,比较规则型或不规则型粗钙化结节与TI-RADS的评分的关系。结果150个粗钙化结节中,病理结果显示良性结节110个,恶性结节40个,均为PTC。PTC患者不规则粗钙化率为80.00%,明显高于良性结节患者的50.91%(P﹤0.01)。40例PTC粗钙化结节中,周边分布11例、中央分布22例、混合分布7例,110例良性结节中,周边分布52例、中央分布26例、混合分布32例。其中PCT患者粗钙化结节中央分布不规则率高于良性结节患者(P﹤0.05)。不规则型粗钙化诊断PTC的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为70.00%、69.09%、45.16%、86.36%、68.00%。病理结果显示,粗钙化结节形态规则62例,不规则88例;TI-RADS评分诊断粗钙化结节形态,在62个规则粗钙化结节中,30个评估正确,32个评估出现偏差;在88个不规则粗钙化结节中,70个评估正确,18个评估出现偏差,其中大部分结节评分偏高,少部分为评分偏低。结论粗钙化结节的形态和分布对PTC筛查具有一定价值,且与TI-RADS分类评分存在一定关联。

Objective Observe the morphological characteristics of the coarse calcification in the nodules of papillary thyroid carcinoma(PTC),and analyze its relationship with the classification score of the thyroid imaging reporting and data system(TI-RADS)and its diagnostic value for PTC.Method 150 patients with thyroid nodules were selected as the research objects.All patients received thyroid ultrasound examination before surgery.Taking pathological examination as the gold standard,it is divided into regular type and irregular type according to the form of coarse calcification,and divided into peripheral type,central type and mixed type according to the distribution method.Analyze the diagnostic value of different shapes and distributions for PTC,and compare the relationship between regular or irregular coarse calcified nodules and the TI-RADS score.Result Among 150 coarse calcified nodules,pathological results showed 110 benign nodules and 40 malignant nodules,all of which were PTC.The rate of irregular coarse calcification in PTC patients was 80.00%,which was significantly higher than 50.91%in patients with benign nodules(P<0.01).In 40 cases of PTC coarse calcified nodules,there were 11 cases of peripheral distribution,22 cases of central distribution and 7 cases of mixed distribution.In 110 cases of benign nodules,there were 52 cases of peripheral distribution,26 cases of central distribution and 32 cases of mixed distribution.The irregular central distribution rate of coarse calcified nodules in patients with PCT was higher than that in patients with benign nodules(P<0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of irregular coarse calcification in the diagnosis of PTC were 70.00%,69.09%,45.16%,86.36%,68.00%,respectively.The pathological results showed that the morphology of coarse calcified nodules was regular in 62 cases and irregular in 88 cases.TI-RADS score was used to diagnose the morphology of coarse calcified nodules.Of the 62 regular coarse calcified nodules,30 nodules were correctly evaluated and 32 nodules were biased;among 88 irregular coarse calcified nodules,70 nodules were correctly evaluated and 18 nodules were biased.Most of them had high scores and a few had low scores.Conclusion The shape and distribution of coarse calcified nodules have a certain value for PTC screening,and there is a certain correlation with the TI-RADS classification score.