CAJ | 학술논문

目的探讨超声对甲状腺乳头状癌(PTC)并存桥本甲状腺炎(HT)的诊断价值.方法 2006年1月至2011年12月经手术病理证实的PTC患者2144例,其中265例并存HT(PTC并存HT组),1879例未并存HT(PTC未并存HT组),对两组患者术前超声资料进行回顾性分析.结果 PTC并存HT组癌结节与PTC未并存HT组癌结节多表现为形态不规则、边界不清楚等超声声像表现(P＞0.05)；PTC未并存HT组癌结节多表现为低回声伴微钙化,PTC并存HT组癌结节则表现为内部回声多样化伴微钙化为主、粗钙化占一定比例(P＜0.01)；PTC并存HT组癌结节血流较PTC未并存HT组并不丰富,主要表现为血流紊乱；与PTC未并存HT组相比,PTC并存HT组癌结节超声诊断准确率低[52.8％( 140/265)比75.0％(1409/1879) ](P＜ 0.01).PTC未并存HT组超声诊断淋巴结转移符合率[ 84.0％ (487/580)]高于PTC并存HT组[74.8％ (77/103)],差异有统计学意义(P＜0.05).结论对于HT病变基础上发现的低回声实性结节、边界不清楚、伴微钙化,应高度怀疑恶变可能；而对于高回声实性结节或粗钙化结节,亦应警惕恶性可能,应进一步观察周围回声及内部血流等特征,综合分析、判断其是否有恶变的可能,尽可能减少对该病的误诊、漏诊.
목적 탐토초성대갑상선유두상암(PTC)병존교본갑상선염(HT)적진단개치.방법 2006년1월지2011년12월경수술병리증실적PTC환자2144례,기중265례병존HT(PTC병존HT조),1879례미병존HT(PTC미병존HT조),대량조환자술전초성자료진행회고성분석.결과 PTC병존HT조암결절여PTC미병존HT조암결절다표현위형태불규칙、변계불청초등초성성상표현(P＞0.05)；PTC미병존HT조암결절다표현위저회성반미개화,PTC병존HT조암결절칙표현위내부회성다양화반미개화위주、조개화점일정비례(P＜0.01)；PTC병존HT조암결절혈류교PTC미병존HT조병불봉부,주요표현위혈류문란；여PTC미병존HT조상비,PTC병존HT조암결절초성진단준학솔저[52.8％( 140/265)비75.0％(1409/1879) ](P＜ 0.01).PTC미병존HT조초성진단림파결전이부합솔[ 84.0％ (487/580)]고우PTC병존HT조[74.8％ (77/103)],차이유통계학의의(P＜0.05).결론 대우HT병변기출상발현적저회성실성결절、변계불청초、반미개화,응고도부의악변가능；이대우고회성실성결절혹조개화결절,역응경척악성가능,응진일보관찰주위회성급내부혈류등특정,종합분석、판단기시부유악변적가능,진가능감소대해병적오진、루진.
Objective To investigate the diagnostic value of ultrasound on patients with papillary thyroid carcinoma (PTC) coexisted with Hashimoto thyroiditis (HT).Methods The preoperative ultrasonography data of 2144 cases with PTC from January 2006 to December 2011 who treated with operation and diagnosed by pathology were analyzed retrospectively.Among them,265 cases coexisted with HT (PTC coexisted with HT group),1879 cases were not coexisted with HT (non-PTC coexisted with HT group).Results Most of the cancerous nodes in two groups exhibited in the ultrasonographic performance just like irregular shape,unclear boundary and so on (P ＞ 0.05).Most of the cancerous nodes in non-PTC coexisted with HT group exhibited hypoechoic nodules with microcalcifications,those in PTC coexisted with HT group exhibited various internal echoes with mainly microcalcifications,and the coarse calcification occupied a certain proportion(P＜ 0.01 ).The cancerous nodes in PTC coexisted with HT group were not rich in blood flow compared with non-PTC coexisted with HT group,but mostly exhibited blood disorders.When compared with non-PTC coexisted with HT group,the rate of ultrasound diagnosis in PTC coexisted with HT group was lower [ 52.8 ％( 140/265 ) vs.75.0 ％ (1409/1879),P ＜ 0.01 ],and the false positive rate in lymph node was higher [84.0％(487/580) vs.74.8％ (77/103)] (P ＜0.05).Conclusions The nodules are malignant when they appear as hypoechoic solid nodules,have unclear boundary and have microcalcifications should be highly suspected.The hyperechoic solid nodules or coarse calcification nodules should also be awared and taken further observation of the characteristics around the echoes and the internal blood flow,making comprehensive analysis to determine whether it could be malignant transformation and try best to reduce the misdiagnosis and missed diagnosis rates of this disease.