CAJ | 학술논문

目的探讨甲状腺部分囊性结节(PCTN)的超声特征,并对其进行分类以鉴别良恶性病变.方法回顾性分析265例PCTN,且经穿刺或手术病理结果证实,观察其超声特征,对其进行统计学分析.结果 265例PCTN中,恶性53例,良性212例.根据超声和病理结果,全组真阳性、真阴性、假阳性、假阴性例数分别为51、208、4、2例,其灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为96.2％ (51/53)、98.1％ (208/212)、92.7％ (51/55)、99.0％ (208/210)和97.7％(259/265).对于PCTN,结节内部结构、形状、边缘与PCTN良恶性有关(均P＜0.001),其中纵横比≥1、边缘毛刺状或微小分叶与恶性PCTN有关,而边缘光滑、海绵状结构与良性PCTN有关.对于PCTN内部实性部分,其结构、游离缘、回声和钙化情况与PCTN良恶性有关(均P＜0.001),其中实性部分偏心结构及锐性夹角、游离缘不光滑、低回声及极低回声、与微小钙化与恶性PCTN有关,而实性部分呈同心结构、游离缘光滑、等回声及高回声、大钙化与良性PCTN有关.Logistic回归分析显示,结节内部实性部分回声、实性部分游离缘、实性部分的结构及钙化为预测恶性PCTN的重要因素(均P＜0.05),其中低回声、极低回声、偏心结构及锐性夹角、游离缘不光滑、微小钙化为预测恶性PCTN的不良因素.结论了解PCTN的恶性特征并做出诊断,对于临床治疗及预后至关重要.
목적 탐토갑상선부분낭성결절(PCTN)적초성특정,병대기진행분류이감별량악성병변.방법 회고성분석265례PCTN,차경천자혹수술병리결과증실,관찰기초성특정,대기진행통계학분석.결과 265례PCTN중,악성53례,량성212례.근거초성화병리결과,전조진양성、진음성、가양성、가음성례수분별위51、208、4、2례,기령민도、특이도、양성예측치、음성예측치화준학솔분별위96.2％ (51/53)、98.1％ (208/212)、92.7％ (51/55)、99.0％ (208/210)화97.7％(259/265).대우PCTN,결절내부결구、형상、변연여PCTN량악성유관(균P＜0.001),기중종횡비≥1、변연모자상혹미소분협여악성PCTN유관,이변연광활、해면상결구여량성PCTN유관.대우PCTN내부실성부분,기결구、유리연、회성화개화정황여PCTN량악성유관(균P＜0.001),기중실성부분편심결구급예성협각、유리연불광활、저회성급겁저회성、여미소개화여악성PCTN유관,이실성부분정동심결구、유리연광활、등회성급고회성、대개화여량성PCTN유관.Logistic회귀분석현시,결절내부실성부분회성、실성부분유리연、실성부분적결구급개화위예측악성PCTN적중요인소(균P＜0.05),기중저회성、겁저회성、편심결구급예성협각、유리연불광활、미소개화위예측악성PCTN적불량인소.결론 료해PCTN적악성특정병주출진단,대우림상치료급예후지관중요.
Objective To explore the ultrasound (US) findings of partially cystic thyroid nodules (PCTNs) and to analyze their relationship with differential diagnosis of benign and malignant lesions.Methods 265 cases of PCTNs confirmed by needle biopsy or surgical pathology were included in this study.Their ultrasound characteristics were reviewed and their significance in differential diagnosis was analyzed.Results In the 265 PTCNs,53 cases were malignant and 212 cases were benign lesions.According to the comparison of ultrasound and pathology results,there were 51 true-positive cases,208 true negative cases,four false-positive cases and two false negative cases; the sensitivity was 96.2％ (51/53),specificity was 98.1％ (208/212),positive predictive value (PPV) was 92.7％ (51/55),negative predictive values (NPV) was 99.0％ (208/210),and accuracy rate was 97.7％ (259/265).In terms of the PTCNs,internal structure,shape and margin were significantly associated with malignant or benign nature (P ＜ 0.001) ; the aspect ratio ≥ 1,spiculated or micro-lobulated margin were significantly associated with malignancy; while the smooth margin,spongiform structure were significantly associated with benign nature.In terms of the internal solid portion of the nodules,the configuration,free margin,echogenecity,and calcification were significantly associated with malignant or benign nature (P ＜ 0.001).The eccentric configuration with an acute angle,non-smooth free margin,hypoechogenecity,marked hypoechogenecity and micro-calcification were significantly associated with malignancy; while concentric configuration,smooth free margin,hyper/isoechogenicity,free margin of the solid component,and macro-calcifications were significantly associated with benign nature (P ＜ 0.01).The results of logistic regression analysis showed that the echogenicity,free margin,configuration and calcification of the solid component were important predictive factors of malignant lesions (P ＜ 0.05),that the hypoechogenecity,marked hypoechogenecity,eccentric configuration with an acute angle,non-smooth free margin and micro-calcification of the internal solid portion of the nodules were predictors for malignant PTCNs (P ＜ 0.01).Conclusion Understanding the characteristics of US findings of partially cystic thyroid nodules is of great importance to make an accurate diagnosis of malignant nodules.