隐匿性甲状腺癌的超声诊断和误诊分析胡烨1俞晓宇2李洁1摘要.DOC

隐匿性甲状腺癌的超声诊断和误诊分析 胡烨作者单位：1. 214002 无锡市 江苏省原子医学研究所附属江原医院超声科 2.病理科 俞晓宇2 作者单位：1. 214002 无锡市 江苏省原子医学研究所附属江原医院超声科 2.病理科 [摘要] 目的：探讨隐匿性甲状腺癌（OCT）的超声特征和误诊原因。材料和方法：回顾性分析30例OCT及7例良性甲状腺小结节患者的超声图像，并与手术病理检查结果对照。结果：37例甲状腺小结节病例中，病理检查证实OCT 30例共38个结节，声像图表现为实性低回声37个（97.4%），33个（86.8%）形态不规则， 17个（44.7%）前后径/上下径（T/L）比值≥1， 19个（50.0%）内部出现点状强回声，彩色多普勒血流显示不丰富36个（94.7%），28个（93.3%）血流阻力指数0.7。超声检查误诊OCT 7例，其中病理检查示慢性淋巴细胞性甲状腺炎伴结节形成3例、结节性甲状腺肿2例、胶原结节2例，其超声表现与OCT有混叠，有3例结节后方回声出现增强。结论:OCT的声像表现有较高特征性，有助于临床对OCT的诊断。但少数甲状腺良性小结节的超声表现与OCT有混叠，易引起误判，应引起重视。 关键词 误诊；甲状腺结节；甲状腺肿瘤；超声检查 中国图书资料分类法分类号 R730.41 The Diagnosis and Pitfalls of Ultrasonography in the Occult Carcinoma of Thyroid Hu Ye, Yu Xiao-yu, Li Jie（Department of Ultrasound，Jiangyuan Hospital, Jiangsu Institute of Nuclear Medicine, Wuxi 214002） [Abstract] Purpose： Occult carcinoma of thyroid (OCT) is difficult to differentiate from benign thyroid nodules because it is small ( 1 cm), often asymptomatic, shares similar ultrasonographic characteristics. The aim of this study was to retrospectively review the ultrasound diagnosis and pitfalls of ultrasound in OCT. Materials and Methods：The ultrasonography in 37 cases suspected of OCT were reviewed, analyzed and compared with histopathology. Results: 30/37 (81.1%) cases (38 nodules) confirmed of OCT were found solid , hypoechogenic nodules in 97.4%,with irregular margins (33/38, 86.8%), longitudinal-to-transverse ratio ≥ 1 (17/38, 44.4%), minute calcification (19/38,50.0%), decreased flow (36/38, 94.7%), and resistance index 0.7 (30/37,81.1%). 7/37 (19.0%) cases of misdiagnosis included 3 chronic lymphocytic thyroiditis with nodules, 2 nodular goiter and 2 collagen nodules. They all had overlapping ultrasonographic features. Conclusion: Those ultrasonographic features were of certain value in OCT. Key words diagnostic pitfall; thyroid nodule; thyroid Neoplasms; ultrasonography 隐匿性甲状腺癌（occult carcinoma of the thyroid，OCT）肿块直径1cm，临床无症状，早期诊断困难［1］。随着对本病认识的提高和健康检查的普及，超声检出率明显提高。但OCT与一些甲状腺良性小结节的超声表现常伴有交叉