超声诊断甲状腺乳头状癌合并桥本甲状腺炎的临床价值

中国医师进修杂志 Pub Date : 2012-10-15 DOI:10.3760/CMA.J.ISSN.1673-4904.2012.29.005

W. Cui, Youzhi Zhu, Xiangjin Chen, Xinmin Lin, Ling-jun Kong

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引用次数: 0

摘要

目的探讨超声对甲状腺乳头状癌(PTC)合并桥本甲状腺炎(HT)的诊断价值。方法回顾性分析2006年1月至2011年12月经手术及病理诊断的2144例PTC术前超声资料。其中合并HT 265例(PTC与HT组共存)，不合并HT 1879例(非PTC与HT组共存)。结果两组癌性淋巴结超声表现多为形状不规则、边界不清等(P < 0.05)。非PTC与HT共存组癌结节多表现为低回声结节伴微钙化，PTC与HT共存组癌结节多表现为各种内部回声，以微钙化为主，粗钙化占一定比例(P< 0.01)。与非PTC合并HT组相比，PTC合并HT组癌淋巴结血流量不丰富，但多表现为血液病。与非PTC合并HT组相比，PTC合并HT组超声诊断率低[52.8%(140/265)比75.0% (1409/1879)，P < 0.01]，淋巴结假阳性率高[84.0%(487/580)比74.8% (77/103)](P <0.05)。结论当结节表现为低回声实性结节，边界不清，伴有微钙化时，应高度怀疑为恶性结节。对高回声实性结节或粗钙化结节也应警惕，进一步观察回声周围特征及内部血流情况，综合分析判断是否为恶性转化，尽量减少本病的误诊漏诊率。关键词:甲状腺炎;甲状腺肿瘤;超声

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The clinical value of ultrasound diagnosis on papillary thyroid carcinoma coexisted with Hashimoto thyroiditis

Objective To investigate the diagnostic value of ultrasound on patients with papillary thyroid carcinoma (PTC) coexisted with Hashimoto thyroiditis (HT).Methods The preoperative ultrasonography data of 2144 cases with PTC from January 2006 to December 2011 who treated with operation and diagnosed by pathology were analyzed retrospectively.Among them,265 cases coexisted with HT (PTC coexisted with HT group),1879 cases were not coexisted with HT (non-PTC coexisted with HT group).Results Most of the cancerous nodes in two groups exhibited in the ultrasonographic performance just like irregular shape,unclear boundary and so on (P ＞ 0.05).Most of the cancerous nodes in non-PTC coexisted with HT group exhibited hypoechoic nodules with microcalcifications,those in PTC coexisted with HT group exhibited various internal echoes with mainly microcalcifications,and the coarse calcification occupied a certain proportion(P＜ 0.01 ).The cancerous nodes in PTC coexisted with HT group were not rich in blood flow compared with non-PTC coexisted with HT group,but mostly exhibited blood disorders.When compared with non-PTC coexisted with HT group,the rate of ultrasound diagnosis in PTC coexisted with HT group was lower [ 52.8 ％( 140/265 ) vs.75.0 ％ (1409/1879),P ＜ 0.01 ],and the false positive rate in lymph node was higher [84.0％(487/580) vs.74.8％ (77/103)] (P ＜0.05).Conclusions The nodules are malignant when they appear as hypoechoic solid nodules,have unclear boundary and have microcalcifications should be highly suspected.The hyperechoic solid nodules or coarse calcification nodules should also be awared and taken further observation of the characteristics around the echoes and the internal blood flow,making comprehensive analysis to determine whether it could be malignant transformation and try best to reduce the misdiagnosis and missed diagnosis rates of this disease. Key words: Thyroiditis; Thyroid neoplasms; Ultrasonography

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中国医师进修杂志

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期刊介绍： Chinese Journal of Postgraduates of Medicine (founded in 1978, monthly) is one of the series of journals of the Chinese Medical Association (CMA) under the supervision of the National Health Commission of the People's Republic of China, sponsored by the Chinese Medical Association (CMA) and Dalian Institute of Theoretical Medicine (DITM). It is a core journal of Chinese science and technology, a statistical source journal of Chinese scientific and technical papers, and a statistical source journal of China Academic Journal Impact Factor Annual Report. The journal adheres to the purpose of using continuing medical education and post training, highlights new theories, new knowledge, new methods and new technologies, and focuses on the combination of theory and practice, and the combination of popularisation and improvement. Main columns: Special tutorials, expert forums, clinical treatises, clinical experience, reviews and lectures, continuing medical education, teaching and research, advanced training forum, drugs and clinics, overview of progress, introduction of new technologies, imaging and clinics, lessons learnt, discussions and evaluations, case reports, discussions of clinical cases, conference proceedings, and domestic and international academic developments. The main target readers are clinical medical personnel in internal medicine, surgery, gynaecology, paediatrics and ophthalmology.