【作者】 张晟； 王晓庆；

【机构】 天津医科大学肿瘤医院超声诊断治疗科 天津市肿瘤防治重点实验室；

【摘要】 目的探讨甲状腺部分囊性结节(PCTN)的超声特征,并对其进行分类以区别良恶性病变。方法回顾性分析265例PCTN,且经穿刺或手术病理结果证实,观察其超声下的特征,对其进行统计学分析。结果 265例PCTN中,恶性53例,良性212例。根据超声和病理结果进行比较,全组真阳性、真阴性、假阳性、假阴性例数分别为51、208、4、2例,其灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为96.2%(51/53)、98.1%(208/212)、92.7%(51/55)、99.0%(208/210)和97.7%(259/265)。对于PCTN,结节内部结构、形状、边缘与PCTN良恶性有关(P<0.001),其中纵横比≥1、边缘毛刺状或微小分叶与恶性PCTN有关,而纵横比<1、边缘光滑、海绵状结构与良性PCTN有关。对于PCTN内部实性部分,其结构、游离缘、回声和钙化情况与PCTN良恶性有关(P<0.001),实性部分偏心结构及锐性夹角、游离缘不光滑、低回声及极低回声、与微小钙化与恶性PCTN有关,而实性部分呈同心结构、游离缘光滑、等回声及高回声、大钙化与良性PCTN有关。Logistic回归分析显示,结节内部实性部分回声、实性成分游离缘、实性部分的结构及钙化为预测恶性PCTN的重要因素(P<0.05),其中低回声、极低回声、偏心结构及锐性夹角、游离缘不光滑、微小钙化为预测恶性PCTN的不良因素。结论了解PCTN的恶性特征并做出诊断,对于临床治疗及预后至关重要。更多还原

【Abstract】 Objective: To seek for the ultrasound(US) findings of partially cystic thyroid nodules(PCTNs) that are associated with malignancy and benign,and classification to distinguish betweenbenign and malignant lesions.Methods: We reviewed the US characteristics of 265 PCTNs, by biopsy or operation pathology confirmed,observing the characteristics of the ultrasound, and analysis.Results: In 265 PTCNs, 53 cases surgically confirmed partially cystic papillary carcinomas, and compared them with those of 212 benign partially cystic nodules.According to the comparison of ultrasound and pathology results, the numbers of true-positive, true-negative, false-positive, and false-negative results for the prospective sonographic diagnosis were 51、208、4 and 2, the sensitivity,specificity, PPV, NPV, and accuracy were 96.2%(51/53),98.1%(208/212),92.7%(51/55),99.0%(208/210),97.7%(259/265). In terms of PTCNs, internal content, shape, and margin were significantly associated with malignancy and benign(p<0.01), a taller-than-wide shape,spiculated or micro-lobulated margin were significantly associated with malignancy,a wider-than-tall shape, smooth margin spongiform appearance were significantly associated with benign; In terms of internal solid portion of the nodule,configuration, free margin, echogenecity, and calcification were significantly associated with malignancy and benign(p<0.01), eccentric configuration with an acute angle, non-smooth free margin, hypoechogenecity, marked hypoechogenecity and micro-calcification were significantly associated with malignancy, concentric configuration, smooth free margin, Hyper/Isoechogenicity, macro-calcifications were significantly associated with benign(p<0.01). According to regression analysis, hypoechogenecity, marked hypoechogenecity, eccentric configuration with an acute angle, non-smooth free margin,macro-calcifications of internal solid portion of the nodule were predictors for the PTCNs(p<0.01). Conclusion: Understanding the characteristics of US findings of partially cystic thyroid nodules is important to make a precise diagnosis of malignant nodules.更多还原