CAJ | 학술논문

目的：探讨超声对甲状腺癌常见的漏误诊原因，以提高甲状腺癌的诊断准确率。方法回顾性分析60例手术后经病理证实的甲状腺癌的声像图特征，分析漏误诊原因。结果66个恶性结节误诊15个，漏诊2个，误诊结节多表现为边界清晰（53％，8／15）、形态规则（73％，11／15）、有晕征（40％，6／15），低／极低回声结节（33％，5／15），仅少部分可见微钙化（27％，4／15），误诊组与未误诊组在边界、形态、晕征、低／极低回声、微钙化、结节内有无回声区等方面比较差异具有统计学意义（ P＜0．05），＜1 cm的结节误诊率高（60％，9／15）。漏诊的2个结节为＜0．4 cm的小结节。15个误诊结节的血供以Ⅰ、0级血流为主，分别占40％（6／15）、27％（4／15），而未误诊组结节以Ⅱ、Ⅲ级血流为主，分别占39％（19／49）、33％（16／49）。2组在血流分级方面比较，差异具有统计学意义（ P ＜0．05）。结论当恶性结节声像图表现为良性结节声像特征、癌结节小且合并多发良性结节时易被漏误诊，检查时应综合分析判断，以减少漏误诊。
목적：탐토초성대갑상선암상견적루오진원인，이제고갑상선암적진단준학솔。방법회고성분석60례수술후경병리증실적갑상선암적성상도특정，분석루오진원인。결과66개악성결절오진15개，루진2개，오진결절다표현위변계청석（53％，8／15）、형태규칙（73％，11／15）、유훈정（40％，6／15），저／겁저회성결절（33％，5／15），부소부분가견미개화（27％，4／15），오진조여미오진조재변계、형태、훈정、저／겁저회성、미개화、결절내유무회성구등방면비교차이구유통계학의의（ P＜0．05），＜1 cm적결절오진솔고（60％，9／15）。루진적2개결절위＜0．4 cm적소결절。15개오진결절적혈공이Ⅰ、0급혈류위주，분별점40％（6／15）、27％（4／15），이미오진조결절이Ⅱ、Ⅲ급혈류위주，분별점39％（19／49）、33％（16／49）。2조재혈류분급방면비교，차이구유통계학의의（ P ＜0．05）。결론당악성결절성상도표현위량성결절성상특정、암결절소차합병다발량성결절시역피루오진，검사시응종합분석판단，이감소루오진。
Objective To evaluate the common reasons of mistaken and missed diagnosis of thyroid cancer , and to improve diagnosis accuracy of ultrasound in thyroid cancer .Methods We retrospectively analyzed the rea‐sons of mistaken and missed diagnosis of 60 cases of thyroid cancer ,which were confirmed by pathology after op‐eration .Results There are 66 malignant nodules ,15 nodules were misdiagnosed ,2 nodules were missed .A part of misdiagnosed nodules showed more clearly boundary(53% ,8/15) ,morphological rules(73% ,11/15) ,halo sign (40% ,6/15) ,hypoechoic appearance(33% ,5/15) ,only a small part with microcalcifications(27% ,4/15) .There were significant differences between misdiagnosis group and no misdiagnosis group in boundary ,form ,halo sign , hypoechoic appearance ,microcalcifications ,cystic component( P<0.05) .It has a high misdiagnosis rate in <1 cm nodules(60% ,9/15) .Two nodules missed are <0 .4 cm small nodules .It is given priority to blood supply with Ⅰ , 0 for 15 misdiagnosed nodules ,accounting for 40% (6/15) ,27% (4/15) ,while not misdiagnosed group nodules inⅡ , Ⅲ blood flow‐oriented ,accounting for 39% (19/49) ,33% (16/49) .The difference between misdiagnosis group and no misdiagnosis group in blood flow grading is significant( P <0 .05) .Conclusion It is easy to be misdiag‐nosed when malignant nodules sonogram showed sonographic features of benign nodules ,which are small and complicated with multiple benign nodules .In order to reduce the mistaken and missed diagnosis of thyroid cancer , comprehensive analysis and judgment should be conducted during the ultrasonography .