超声检查在甲状腺大结节成年患者中的应用价值

Application value of ultrasound in adult patients with thyroid nodules≥3 cm

目的明确≥3.0 cm甲状腺结节(TNS)和<3.0 cm TNS的超声(US)影像差异,探讨超声在≥3.0 cm甲状腺结节患者中的应用价值。方法选择2017年3月—2019年8月在平煤神马医疗集团总医院、新乡医学院三全学院、濮阳市油田总医院进行US检查并行甲状腺手术切除的患者545例。根据甲状腺结节最大直径将患者分为大结节组(115例,152个结节)和小结节组(352例,417个结节)。大结节组为甲状腺结节≥3.0 cm的患者;小结节组为甲状腺结节<3.0 cm的患者。对比分析甲状腺大结节与小结节患者的临床与US影像特点。结果(1)大结节组患者的微钙化率(28.94%)、低回声率(40.13%)、形态不规则率(13.82%)均高于小结节组患者(18.94%、7.19%、3.36%,均P<0.05);大结节组患者的囊性结构率(9.21%)、混合性结节率(30.26%)、高回声率(30.92%)、结节周围血管率(4.61%)均低于小结节组患者(18.94%、48.44%、42.93%、13.43%,均P<0.05)。(2)甲状腺大结节与小结节的TI-RADS分级诊断结果比较,差异无统计学意义(P>0.05)。(3)US检查对甲状腺大结节诊断的正确率为74.3%(113/152)。大结节是甲状腺结节恶性的危险因素(OR=2.674,95%CI:1.116~6.405,P=0.027)。结论≥3.0 cm的TNS患者US特征和<3.0 cm的TNS患者US特征存在差异。与甲状腺小结节相比较,甲状腺大结节具有更高的恶变风险。

Objective To clarify the difference of ultrasound(US)images between≥3.0 cm thyroid nodules(TNS)and<3.0 cm TNS,and to explore the application value of US in patients with≥3.0 cm thyroid nodules.Methods From March 2017 to August 2019,545 patients underwent US examination and thyroid surgery in the Shenma Medical Group General Hospital,Sanquan College,and Oilfield General Hospital of Puyang City were selected and divided into the large nodule group(115 cases,152 nodules)and small nodule group(352 cases,417 nodules)according to the maximum diameter of thyroid nodules.The large nodule group comprised patients with thyroid nodules≥3.0 cm,whereas patients with thyroid nodules<3.0 cm were in the small nodule group.The clinical and US imaging features were compared between the two groups.Results(1)The microcalcification rate(28.94%),hypoechoic rate(40.13%)and irregular shape rate(13.82%)in patients with large nodules were higher than those in patients with small nodules(18.94%,7.19%and 3.36%,respectively,all P<0.05).The cystic structure rate(9.21%),mixed nodule rate(30.26%),hyperechoic rate(30.92%)and perinodal vascular rate(4.61%)in patients with large nodules were lower than those in patients with small nodules(18.94%,48.44%,42.93%and 13.43%,respectively,all P<0.05).(2)No significant difference was found between the diagnosis results of TI-RADS classification of large thyroid nodules and small thyroid nodules(P>0.05).(3)The correct rate of US in diagnosing large thyroid nodules was 74.3%(113/152).Large nodules were the risk factors of malignant thyroid nodules(OR=2.674,95%CI:1.116-6.405,P=0.027).Conclusion There are differences in US characteristics between patients with TNS≥3.0 cm and patients with TNS<3.0 cm.Compared with small thyroid nodules,large thyroid nodules have a higher risk of malignant transformation.