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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2017, Vol. 14 ›› Issue (10) : 755 -759. doi: 10.3877/cma.j.issn.1672-6448.2017.10.008

所属专题： 文献；

浅表器官超声影像学

超声在甲状腺结节合并环状钙化的良恶性诊断中的应用
华翠萍1, 王建伟1, 郭智兴1, 林庆光1, 邹学彬1, 赖子敏1, 陈珏铭1, 韩峰1,†()   
  1. 1. 510060　广州，中山大学肿瘤防治中心超声心电科
  • 收稿日期:2016-12-11 出版日期:2017-10-01
  • 通信作者: 韩峰

Ultrasonography in the diagnosis of benign and malignant thyroid nodules with rim calcification

Cuiping Hua1, Jianwei Wang1, Zhixing Guo1, Qingguang Lin1, Xuebin Zou1, Zimin Lai1, Jueming Chen1, Feng Han1,†()   

  1. 1. Department of Ultrasound, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
  • Received:2016-12-11 Published:2017-10-01
  • Corresponding author: Feng Han
  • About author:
    Corresponding author: Han Feng, Email:
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引用本文：

华翠萍, 王建伟, 郭智兴, 林庆光, 邹学彬, 赖子敏, 陈珏铭, 韩峰. 超声在甲状腺结节合并环状钙化的良恶性诊断中的应用[J]. 中华医学超声杂志（电子版）, 2017, 14(10): 755-759.

Cuiping Hua, Jianwei Wang, Zhixing Guo, Qingguang Lin, Xuebin Zou, Zimin Lai, Jueming Chen, Feng Han. Ultrasonography in the diagnosis of benign and malignant thyroid nodules with rim calcification[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(10): 755-759.

目的

探讨甲状腺结节合并环状钙化的超声特征在良恶性鉴别诊断中的价值。

方法

选取2008年1月至2015年12月在中山大学肿瘤防治中心就诊的甲状腺结节合并环状钙化的患者60例，收集患者的超声特征，包括结节大小、边缘、内部回声、生长方式、后方回声、钙化环的连续性及钙化环周围有无低回声软组织影。以病理结果作为"金标准"，分析超声在合并环状钙化的甲状腺结节良恶性诊断中的价值。

结果

60个病灶中，良性结节37例（61.7%），恶性结节23例（38.3%）。恶性结节钙化环连续性中断或内陷比率，以及环状钙化周围低回声软组织影出现率均明显高于良性结节。钙化环连续性中断、周围出现低回声软组织影超声特征对良恶性的诊断敏感度分别为85.7%、81.3%，特异度分别为89.4%、94.4%，阳性预测值分别为85.7%、92.9%，阴性预测值分别为89.4%、85.0%。恶性结节相较于良性结节，钙化环内部常为低回声（82.6% vs 40.5%），更易出现纵向生长（30.4% vs 2.7%），差异均有统计学意义（χ2=9.958、9.440，P均<0.01）。而良恶性结节的大小、边缘、后方回声比较，差异均无统计学意义（P均>0.05）。

结论

环状钙化灶周边低回声软组织影与环状钙化连续性中断或内陷等超声征象在鉴别甲状腺结节的良恶性中有重要意义。

关键词: 甲状腺结节, 环状钙化, 超声检查, 鉴别诊断
Objective

The aim of this study was to investigate the value of ultrasound in diagnosis of benign and malignant thyroid nodules with rim calcification.

Methods

Sixty thyroid nodules with rim calcifications from Sun Yat-sen University Cancer center which were detected on ultrasound from January 2008 to December 2015 were included in this study, and all the thyroid nodules had pathological results. Ultrasonic features of thyroid nodules, including the size, border, internal echo, growth pattern, rear echo, interruption or inner sink of the rim calcification and hypoechoic soft tissue extrusion around rim calcification were analyzed.

Results

Thirty-seven nodules (61.7%) were confirmed to be benign, and twenty-three nodules (38.3%) were malignant. The ultrasonic features of interruption or inner sink of rim calcifications and hypoechoic soft tissue extrusion around rim calcification, were more often in malignant nodules than benign nodules. The sensitivity, specificity, the positive predictive values and the negative predictive values for interruption or inner sink of rim calcifications were 85.7%, 89.4%, 85.7% and 89.4%, respectively. The sensitivity, specificity, the positive predictive values and the negative predictive values for hypoechoic soft tissue extrusion around rim calcification were 81.3%, 94.4%, 92.9% and 85.0%, respectively. Internal hypoechogenicity was more frequently observed in the malignant nodules (82.6%) than in benign nodules (40.5%). The longitudinal growth pattern of thyroid was more frequently observed in malignant nodules (30.4%) than in benign nodules (2.7%). The differences of this two ultrasound features were statistically significant (χ2=9.958 and 9.440, both P<0.01). There were no significant differences in size, border and the rear echo between malignant and benign nodules (all P>0.05).

Conclusion

The interruption or inner sink of the rim calcification could be useful in differential diagnosis of thyroid nodules with rim calcification.

Key words: Thyroid nodules, Rim calcification, Ultrasonography, Differential diagnosis
图3 甲状腺滤泡状癌患者伴连续性中断的钙化环超声图像。患者，女性，64岁，右侧叶中部不均匀低回声灶，伴连续性中断的钙化环（白色箭头所示），病灶周边可见薄层低回声软组织影（蓝色箭头所示），术后病理示滤泡状癌
表1 良性与恶性结节组甲状腺伴环状钙化结节的超声表现
组别 例数 病灶大小（mm，±s） 生长方式 边缘 内部回声
长径 短径 平行生长 纵向生长 完整 不完整 高/等回声 低/极低回声 无法辨认
良性结节组 37 14.69±1.68 10.98±1.03 36 1 32 5 10 17 10
恶性结节组 23 16.65±1.65 12.61±1.28 16 7 17 6 0 19 4
统计值 ? t=0.782 t=0.983 χ2=9.440 χ2=0.776 χ2=9.958
P值 ? 0.437 0.330 0.002 0.379 0.007
组别 例数 后方回声 钙化环连续性 周围软组织影
无明显改变 衰减 增强 连续 中断或内陷 有 无
良性结节组 37 14 21 2 24 13 12 25
恶性结节组 23 12 9 2 8 15 14 9
统计值 ? χ2=1.794 χ2=5.157 χ2=4.671
P值 ? 0.408 0.023 0.031
[1]
Cronan JJ. Thyroid nodules: is it time to turn off the US machines? [J]. Radiology, 2008, 247(3):602-604.
[2]
Russ G, Royer B, Rouxel A, et al. Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography [J]. Eur J Endocrinol, 2013, 168(5):649-655.
[3]
Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer [J]. Thyroid, 2016, 25(1):1-133.
[4]
Remonti LR, Kramer CK, Leitão CB, et al. Thyroid ultrasound features and risk of carcinoma: A systematic review and meta-analysis of observational studies [J]. Thyroid, 2015, 25(5):538-550.
[5]
Woliński K, Szkudlarek M, Szczepanek-Parulska E, et al. usefulness of different ultrasound features of malignancy in predicting the type of thyroid lesions: a meta - analysis of prospective studies [J]. Pol Arch Med Wewn, 2014, 124(3):97-104.
[6]
Kim EK, Park CS, Chung WY, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid [J]. AJR Am J Roentgenol, 2002, 178(3):687-691.
[7]
Yoon DY, Lee JW, Chang SK, et al. Peripheral calcification in thyroid nodules: ultrasonographic features and prediction of malignancy [J]. J Ultrasound Med, 2007, 26(10):1349-1355.
[8]
王建伟，韩峰，李安华, 等. 高频超声对甲状腺病灶伴蛋壳样钙化的诊断价值 [J]. 中国医学影像技术, 2013, 29(3):358-361.
[9]
Park YJ, Kim JA, Son EJ, et al. Thyroid nodules with macrocalcification: sonographic findings predictive of malignancy [J]. Yonsei Med J, 2014, 55(2):339-344.
[10]
穆红艳，陈若宇，王喜安, 等. 高频超声探测甲状腺结节钙化模式与甲状腺癌的相关性 [J]. 海军医学杂志, 2015, 17(2):116-118.
[11]
Lee SK, Rho BH. Follicular thyroid carcinoma with an eggshell calcification: report of 3 cases [J]. J Ultrasound Med, 2009, 28(6):801-806.
[12]
Moon WJ, Jung SL, Lee JH, et al. Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study [J]. Radiology, 2008, 247(3):762-770.
[13]
刘燕，张丽平，王蓓蓓, 等. 超声钙化分型对甲状腺钙化结节良恶性的诊断价值 [J]. 中国实用医药, 2013, 8(26):3-4.
[14]
Wang N, Xu Y, Ge C, et al. Association of sonographically detected calcification with thyroid carcinoma [J]. Head Neck, 2006, 28(12):1077-1083.
[15]
Kim BK, Choi YS, Kwon HJ, et al. Relationship between patterns of calcification in thyroid nodules and histopathologic findings [J]. EJ Advance Publication, 2010, 12(2):1507-1510.
[16]
Frates MC, Benson CB, Doubilet PM, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography [J]. J Clin Endocrinol Metab, 2006, 91(9):3411-3417.
[17]
Chen G, Zhu XQ, Zou X, et al. Retrospective analysis of thyroid nodules by clinical and pathological characteristics, and ultrasonographically detected calcification correlated to thyroid carcinoma in South China [J]. Eur Surg Res, 2009, 42(3):137-142.
[18]
Kakkos SK, Scopa CD, Chalmoukis AK, et al. Relative risk of cancer in sonographically detected thyroid nodules with calcifications [J]. J Clin Ultrasound, 2000, 28(7):347-352.
[19]
彭梅，张学珍，王圣应, 等. 甲状腺钙化结节的超声分型探讨 [J]. 中华全科医学, 2009, 7(2):201-202.
[20]
谭小蕖，钱林学，赵军凤, 等. 不同类型甲状腺钙化结节超声病理相关性研究 [J]. 临床和实验医学杂志, 2014, 23(13):1671-1673.
[21]
徐上妍，詹维伟，周建桥, 等. 超声评估甲状腺结节内钙化的初步探讨 [J]. 中国超声医学杂志, 2012, 28(9):789-792.
[22]
Hoang JK, Lee WK, Lee M, et al. US features of thyroid malignancy: pearls and pitfalls [J]. Radiographics, 2007, 27(3):847-865.
[23]
Park M, Shin JH, Han BK, et al. Sonography of thyroid nodules with peripheral calcifications [J]. J Clin Ultrasound, 2009, 37(6):324-328.
[24]
Kim MJ, Kim EK, Kwak JY, et al. Differentiation of thyroid nodules with macrocalcifications: role of suspicious sonographic findings [J]. J Ultrasound Med, 2008, 27(8):1179-1189.
[25]
Frates MC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement [J]. Radiology, 2005, 237(3):794-800.
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