不同类型钙化在甲状腺良恶性结节超声鉴别诊断中的意义(1)
摘要：目的 旨在讨论不同类型钙化对甲状腺良恶性结节在超声鉴别诊断中的价值。方法 对经手术治疗的甲状腺结节患者的病理结果与其术前高频超声检查声像图进行回顾性对比研究分析。结果 500例结节中，恶性结节125例，良性结节375例，含钙化结节123个，总钙化率为24.60%，恶性含钙化结节77个，总钙化率为61.60%(77/125)，良性含钙化结节46例，总钙化率为12.30%(46/375)，恶性结节中含微钙化的甲状腺结节占63.60%(49/77)，其中微钙化呈簇状或密集分布的结节22例，占恶性微钙化结节的44.80%(22/49)，含粗大钙化的甲状腺结节16例，占恶性结节的20.70%(16/77)，边缘环状钙化的甲状腺结节12例，占恶性结节的15.60%(12/77)。结论 含任何类型钙化的甲状腺结节均有恶性的风险，而微小钙化在甲状腺恶性结节中的发生率明显高于良性结节，在甲状腺良恶性结节鉴别诊断中具有特异性，尤其是簇状分布或密集分布的微小钙化结节恶性风险更高，粗大钙化及边缘环状钙化恶性风险虽小于微小钙化，但仍有恶性的风险，应结合甲状腺结节形态、边界、回声及血流分布情况来减少恶性结节漏诊及误诊的发生率。
, 百拇医药
关键词：甲状腺；钙化；微小钙化
中圖分类号：R445.1 文献标识码：A 文章编号：1006-1959(2017)25-0181-03
Abstract：Objective To discuss the value of different types of calcification in the differential diagnosis of benign and malignant thyroid nodules in ultrasound.Methods The pathological results of surgical treatment of thyroid nodule patients with preoperative high frequency ultrasound sonogram were retrospectively analysed.Results 500 cases of nodules，125 cases of malignant nodules，benign nodules in 375 cases with calcification 123 nodules，the total calcification rate was 24.6%，including 77 malignant nodules，the total calcification rate was 61.6%(77/125)，46 cases with benign nodules of calcification，the total calcification rate was 12.3%(46/375)，thyroid nodules with microcalcification in malignant nodules accounted for 63.6%(49/77)，The microcalcification clusters or dense nodules in 22 cases，accounting for 44.8% of the malignant calcification nodules(22/49)，16 cases of thyroid nodules with macrocalcification，accounting for 20.7% of malignant nodules(16/77)，12 cases of thyroid nodules in peripheral calcification， accounting for 15.6% of malignant nodules(12/77).Conclusion Any the type of calcification of thyroid nodules were malignant risk，and microcalcification in thyroid malignant nodules was significantly higher than that of benign nodules，with specificity in the differential diagnosis of benign and malignant thyroid nodules， especially clustered microcalcifications or malignant nodules are densely distributed higher risk， macrocalcification and malignant peripheral calcification are at risk less than small calcification，but there is still a risk of malignant thyroid nodules， should be combined with morphology，boundary，echo and blood flow distribution of incidence of malignant nodules to reduce misdiagnosis and missed diagnosis.
, http://www.100md.com
Key words：Thyroid；Calcification；Microcalcification
甲状腺是人体最大的分泌腺，近年来随着人们饮食 结 构 的 不 断 改 变，甲状腺结节在临床中的发病率逐年增高，且甲状腺癌的发病率亦呈上升趋势[1]，目前有多种临床手段可评估甲状腺结节的良恶性，其中细针穿刺抽吸细胞活检是有效的鉴别方法，但因其为有创性检查，且存在一定的假阴性率，患者依从性差等特点，临床应用受到限制，无创性手段如CT、MRI，CT可了解肿瘤对周围组织的侵犯情况，但其影像学表现有一定重叠，造成诊断困难[2]，MRI因价格昂贵而无法在临床广泛开展[3]，而超声以其无创、高分辨率、高性价比、便捷的特点，成为评估甲状腺结节性质的首选手段，正确评价甲状腺良恶性结节，对指导临床手术方案选择，避免过度治疗，降低医疗成本、减少医疗风险、对提高患者生活质量具有重要意义，而钙化为甲状腺结节常见的超声表现，其与甲状腺癌的相关性为许多研究所证实，本文旨在讨论不同类型的钙化对甲状腺良恶性结节在超声鉴别诊断中的意义，以提高诊断准确性。, http://www.100md.com(汪洋 李存芬)
, 百拇医药
关键词：甲状腺；钙化；微小钙化
中圖分类号：R445.1 文献标识码：A 文章编号：1006-1959(2017)25-0181-03
Abstract：Objective To discuss the value of different types of calcification in the differential diagnosis of benign and malignant thyroid nodules in ultrasound.Methods The pathological results of surgical treatment of thyroid nodule patients with preoperative high frequency ultrasound sonogram were retrospectively analysed.Results 500 cases of nodules，125 cases of malignant nodules，benign nodules in 375 cases with calcification 123 nodules，the total calcification rate was 24.6%，including 77 malignant nodules，the total calcification rate was 61.6%(77/125)，46 cases with benign nodules of calcification，the total calcification rate was 12.3%(46/375)，thyroid nodules with microcalcification in malignant nodules accounted for 63.6%(49/77)，The microcalcification clusters or dense nodules in 22 cases，accounting for 44.8% of the malignant calcification nodules(22/49)，16 cases of thyroid nodules with macrocalcification，accounting for 20.7% of malignant nodules(16/77)，12 cases of thyroid nodules in peripheral calcification， accounting for 15.6% of malignant nodules(12/77).Conclusion Any the type of calcification of thyroid nodules were malignant risk，and microcalcification in thyroid malignant nodules was significantly higher than that of benign nodules，with specificity in the differential diagnosis of benign and malignant thyroid nodules， especially clustered microcalcifications or malignant nodules are densely distributed higher risk， macrocalcification and malignant peripheral calcification are at risk less than small calcification，but there is still a risk of malignant thyroid nodules， should be combined with morphology，boundary，echo and blood flow distribution of incidence of malignant nodules to reduce misdiagnosis and missed diagnosis.
, http://www.100md.com
Key words：Thyroid；Calcification；Microcalcification
甲状腺是人体最大的分泌腺，近年来随着人们饮食 结 构 的 不 断 改 变，甲状腺结节在临床中的发病率逐年增高，且甲状腺癌的发病率亦呈上升趋势[1]，目前有多种临床手段可评估甲状腺结节的良恶性，其中细针穿刺抽吸细胞活检是有效的鉴别方法，但因其为有创性检查，且存在一定的假阴性率，患者依从性差等特点，临床应用受到限制，无创性手段如CT、MRI，CT可了解肿瘤对周围组织的侵犯情况，但其影像学表现有一定重叠，造成诊断困难[2]，MRI因价格昂贵而无法在临床广泛开展[3]，而超声以其无创、高分辨率、高性价比、便捷的特点，成为评估甲状腺结节性质的首选手段，正确评价甲状腺良恶性结节，对指导临床手术方案选择，避免过度治疗，降低医疗成本、减少医疗风险、对提高患者生活质量具有重要意义，而钙化为甲状腺结节常见的超声表现，其与甲状腺癌的相关性为许多研究所证实，本文旨在讨论不同类型的钙化对甲状腺良恶性结节在超声鉴别诊断中的意义，以提高诊断准确性。, http://www.100md.com(汪洋 李存芬)
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