甲状腺木乃伊结节超声误诊分析

Misdiagnosis of Mummified Thyroid Nodules by Ultrasonography

目的分析甲状腺木乃伊结节超声检查误诊原因,并总结防范误诊措施。方法回顾性分析超声检查误诊的甲状腺木乃伊结节20例的临床资料。结果本组均因甲状腺结节就诊,皆为单发,10例位于左侧叶,8例位于右侧叶,2例位于峡部。20例常规超声检查均误诊为甲状腺乳头状癌,3例评估为影像报告与数据系统(TI-RADS)4b类,10例评估为TI-RADS 4c类,7例评估为TI-RADS 5类。误诊时间2~5个月。7例行超声造影检查,其中5例无增强,2例呈不均匀低增强。20例均经病理学检查确诊,其中16例行细针穿刺细胞学检查,4例行甲状腺单侧叶切除术后病理检查。手术4例,皆恢复良好;未手术16例随访观察6~24个月,4例结节体积略缩小,12例结节形态和大小未见明显变化。结论甲状腺木乃伊结节超声表现缺乏特异性,极易误诊。结节呈实性低回声或极低回声、黑白双层晕环征、结节体积缩小和超声造影显示结节内无增强是其特异性超声表现。接诊医师应熟悉该病超声声像图特征,重视病史采集,综合分析病灶性质,对于不典型结节建议行活组织病理检查,以减少或避免误诊误治。

Objective To analyse the causes of misdiagnosis and preventative measures of mummified thyroid nodules by ultrasonography.Methods Clinical data of 20 patients misdiagnosed by ultrasonography was retrospectively analyzed.Results All patients in this group presented with single thyroid nodules,with 10 cases located in the left lobe,8 cases located in the right lobe,and 2 cases located in the isthmus.All 20 cases were misdiagnosed as papillary thyroid carcinoma by conventional ultrasound at initial examination.Three nodules showed thyroid imaging reporting and data system(TI-RADS)score 4b,10 nodules showed TI-RADS score 4c,7 nodules showed TI-RADS score 5.The duration of misdiagnosis was 2-5 months.Seven cases were examined by contrast-enhanced ultrasound,of which 5 cases showed no enhancement and 2 cases showed hypoenhancement.All 20 cases were confirmed by pathological examination,including 16 cases of cytopathologic examination and 4 cases of partial thyroidectomy.Four cases recovered well after operation.Another 16 patients without operation were followed up for 6-24 months.The nodule volume decreased slightly in 4 patients,and the shape and size of the nodule did not change significantly in 12 patients.Conclusion The ultrasonic features of mummified thyroid nodules are lack of specificity,which are,therefore,easily misdiagnosed.The specific ultrasonic manifestations of the nodules are solid hypoechoic or extremely hypoechoic,black-and-white double halo sign,reduced nodule volume,and no enhancement in the nodules as shown by contrast-enhanced ultrasound.The physician should be familiar with the sonographic characteristics of the disease,pay attention to the collection of the medical history,comprehensively analyze the nature of the lesions,and recommend pathological biopsy for atypical nodules to reduce or avoid misdiagnosis and mistreatment.