Differentiation of 2.0～4.0 mm benign small thyroid nodules from malignant ones by ultrasound
LIU Shu-yu1, GU Ying2, HAN Zhi-jiang2, WANG Yan1
1. Department of Ultrasound, First People’s Hospital of Hangzhou Fuyang Area, Hangzhou 311400, China;
2. First People’s Hospital of Hangzhou City, Hangzhou 310006, China
摘要目的：探讨超声在2.0～4.0 mm甲状腺良、恶性微小结节鉴别诊断中的价值。方法：回顾分析经手术及病理证实的359例共412枚最大径在2.0～4.0 mm甲状腺微小结节的超声资料，其中甲状腺微小乳头状癌（PTMC）173例共194枚，微小结节性甲状腺肿（MNG）179例共204枚，PTMC合并MNG 7例共PTMC 7枚和MNG 7枚，观察结节形态不规则、低回声、纵横比≥1和微钙化在PTMC和MNG中的分布。结果：结节形态不规则（χ2=261.967，P＜0.05）、低回声（χ2=17.259，P＜0.05）、纵横比≥1（χ2=249.703，P＜0.05）在2.0～4.0 mm PTMC与MNG中均具有统计学差异，微钙化无统计学差异（χ2=1.155，P＞0.05）。纵横比≥1的特异度（92.9%）、阳性预测值（91.9%）、准确度（88.8%）均最高，形态不规则阴性预测值最高（94.4%），低回声的敏感度（97.0%）最高，其特异度（14.7%）最低。结论：在2.0～4.0 mm PTMC和MNG的鉴别诊断中，形态不规则和纵横比≥1是两个重要征象，尽管低回声对PTMC具有高度的敏感度，但特异度低而限制其临床应用。
Abstract：Objective: To investigate the diagnostic value of ultrasound for differentiating 2.0～4.0 mm benign small thyroid nodules from malignant ones. Methods: Ultrasonic data of 412 small thyroid nodules with maximum diameter of 2.0～4.0 mm, collected from 359 cases by operation and pathology, were analyzed retrospectively, including 173 cases of papillary thyroid microcarcinoma(PTMC, 194 nodules), 179 cases of micronodular goiter(MNG, 204 nodules) and 7 cases of PTMC(7 nodules) and MNG(7 nodules). Morphology, low echo, aspect ratio≥1 and distribution of micro-calcification in PTMC and MNG were observed. Results: Statistical differences were found in irregular morphology, low echo and aspect ratio≥1(χ2=261.967, P＜0.05; χ2=17.259, P＜0.05; χ2=249.703, P＜0.05) between 2.0～4.0 mm nodules of PTMC and MNG, but no difference was found in micro-calcification(χ2=1.155, P＞0.05). Aspect ratio≥1 had the highest specificity(92.9%), positive predictive value(91.9%) and accuracy(88.8%). Irregular morphology had the highest negative predictive value(94.4%). Low echo had the highest sensitivity(97.0%) and lowest specificity(14.7%). Conclusions: Irregular morphology and aspect ratio≥1 are the two important signs for differential diagnosis of 2.0～4.0 mm PTMC from MNG. Although low echo has a high sensitivity for PTMC, its low specificity limits clinical application.
刘书宇1，谷 莹2，韩志江2，王 琰1. 超声在2.0～4.0 mm甲状腺良、恶性微小结节鉴别诊断中的价值[J]. 中国临床医学影像杂志, 2017, 28(6): 397-399.
LIU Shu-yu1, GU Ying2, HAN Zhi-jiang2, WANG Yan1. Differentiation of 2.0～4.0 mm benign small thyroid nodules from malignant ones by ultrasound. JOURNAL OF CHINA MEDICAL IMAGING, 2017, 28(6): 397-399.
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