摘要
目的探讨甲状腺部分囊性结节（PCTN）的超声特征，并对其进行分类以鉴别良恶性病变。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，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（均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（均P〈0．001），其中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、实性部分游离缘、实性部分的结构及钙化为预测恶性PCTN的重要因素（均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。
Objective To explore the ultrasound （US） findings of partially cystic thyroid nodules （PCTNs） and to analyze their relationship with differential diagnosis of benign and malignant lesions. Methods 265 cases of PCTNs confirmed by needle biopsy or surgical pathology were included in this study. Their ultrasound characteristics were reviewed and their significance in differential diagnosis was analyzed. Results In the 265 PTCNs, 53 cases were malignant and 212 cases were benign lesions. According to the comparison of ultrasound and pathology results, there were 51 true-positive cases, 208 true negative cases, four false-positive cases and two false negative cases;the sensitivity was 96.2% （51/53）, specificity was 98.1% （ 208/212 ）, positive predictive value （ PPV ） was 92.7% （ 51/55 ）, negative predictive values （NPV） was 99.0% （208/210）, and accuracy rate was 97.7% （259/265）. In terms of the PTCNs, internal structure, shape and margin were significantly associated with malignant or benign nature （ P 〈 0.001 ） ; the aspect ratio ≥ 1, spiculated or micro-lobulated margin were significantly associated with malignancy; while the smooth margin, spongiform structure were significantly associated with benign nature. In terms of the internal solid portion of the nodules, the configuration, free margin, echogenecity, and calcification were significantly associated with malignant or benign nature （P 〈 0. 001 ）. The eccentric configuration with an acute angle, non-smooth free margin, hypoechogenecity, marked hypoechogenecity and micro-calcification were significantly associated with malignancy; while concentric configuration, smooth free margin, hyper/isoechogenicity, free margin of the solid component, and macro-calcifications were significantly associated with benign nature （ P 〈 0.01 ）. The results of logistic regression analysis showed that the echogenicity, free margin, configuration and calcification of the solid component were important predictive factors of malignant lesions （ P 〈 0.05 ）, that the hypoechogenecity, marked hypoechogenecity, eccentric configuration with an acute angle, non-smooth free margin and micro-calcification of the internal solid portion of the nodules were predictors for malignant PTCNs （ P 〈 O. O1 ）. Conclusion Understanding the characteristics of US findings of partially cystic thyroid nodules is of great importance to make an accurate diagnosis of malignant nodules.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2014年第8期617-620,共4页
Chinese Journal of Oncology
关键词
甲状腺肿瘤
甲状腺结节
超声检查
诊断
因素分析
统计学
Thyroid neoplasms
Thyroid nodule
Uhrasonography
Diagnosis
Factoranalysis, statistical
