超声对易误诊的等回声、高回声甲状腺结节良恶性的鉴别

Differential diagnosis of easily misdiagnosed benign and malignant isoechoic and hyperechoic thyroid nodules by ultrasound

目的评价超声鉴别等回声、高回声甲状腺结节良恶性的价值。方法回顾性分析2019年8月至2020年12月在苏州大学附属第三医院经手术病理证实的128个等回声、高回声甲状腺结节的超声声像图资料。以病理结果为金标准,将甲状腺结节分为良性组(n=94)和恶性组(n=34)。评估结节的超声特征,包括回声、边缘、生长方式、钙化、声晕、回声质地、后方回声、结中结表现、囊性变和血流。采用独立样本t检验、χ^(2)检验或Fisher精确检验比较良恶性组间超声特征的差异。绘制受试者操作特征(ROC)曲线,计算曲线下面积(AUC)分析各超声特征参数的诊断效能。结果恶性组中结节边缘不光整(38.2%vs 5.3%,P<0.001)、垂直位生长(17.6%vs 2.1%,P=0.004)、含有钙化(73.5%vs 17.0%,P<0.001)、回声质地不均匀(94.1%vs 55.3%,χ^(2)=16.53,P<0.001)、少许血流(79.4%vs 57.4%,P=0.017)均较良性组多见,且差异均具有统计学意义。有、无声晕在良恶性组间差异无统计学意义(P>0.05),但在有声晕的结节中,声晕厚度不一致(84.2%vs 8.2%,χ^(2)=37.58,P<0.001)提示与恶性相关。结节回声质地不均匀诊断敏感度最高,为94.12%,垂直位生长诊断特异度最高,为97.87%,声晕厚度不一致的AUC和诊断准确性最高,分别为0.880和89.71%。结论等回声、高回声甲状腺结节边缘不光整、垂直位生长、存在粗大钙化或微钙化、声晕厚度不一致、回声质地不均匀以及少许血供有助于诊断恶性结节。

Objective To evaluate the diagnostic value of ultrasound in isoechoic and hyperechoic thyroid nodules.Methods A retrospectively analysis was performed on the ultrasonographic data of 128 cases of isoechoic and hyperechoic thyroid nodules confirmed by surgery and pathology at the Third Affiliated Hospital of Soochow University from August 2019 to December 2020.Based on the pathological results as the gold standard,there were 94 cases of benign nodules and 34 cases of malignant nodules.The ultrasonic features of nodules,including echo,margin,growth mode,calcification,halo,echo texture,posterior echo,nodule-in-nodule architecture,cystic change,and blood flow,were evaluated.Independent sample t-test,χ^(2)test,or Fisher's exact test was used for statistical comparison of ultrasonic features between groups.The diagnostic efficacy of each parameter was analyzed using the receiver operating characteristic(ROC)curve and the area under curve(AUC).Results In the benign and malignant groups,irregular margin of the nodule(38.2%vs 5.3%,P<0.001),vertical growth(17.6%vs 2.1%,P=0.004),calcification(73.5%vs 17.0%,P<0.001),uneven echo texture(94.1%vs 55.3%,χ^(2)=16.53,P<0.001),and a little blood flow(79.4%vs 57.4%,P=0.017)all suggested the risk of malignancy.There was no difference in the presence or absence of halo between the two groups(P>0.05).In nodules with halo,inconsistent halo thickness(84.2%vs 8.2%,χ^(2)=37.58,P<0.001)suggested the risk of malignancy.The diagnostic sensitivity of uneven echo texture of nodules(94.12%)was the highest,and the diagnostic specificity of vertical growth(97.87%)was the highest.The AUC and diagnostic accuracy of inconsistent sound halo thickness were the highest(0.880 and 89.71%,respectively).Conclusion Isoechoic and hyperechoic nodules with irregular edges,vertical growth,coarse calcification or microcalcification,inconsistent thickness of acoustic halo,uneven echo texture,and a little blood supply are helpful to the diagnosis of malignant nodules.