超声误诊为甲状腺癌的良性病变超声与病理对照分析

发布时间：2018-03-02 12:37

本文选题：超声检查　切入点：误诊　出处：《山西医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:分析超声误诊为甲状腺癌的甲状腺良性病变的超声声像图特征,从病理角度探讨其误诊原因,提高超声对甲状腺良性病变的诊断准确率。方法:选择2012年12月至2014年5月于山西省肿瘤医院就诊并经手术病理证实的甲状腺良性病变患者578例,术前超声诊断以甲状腺超声影像报告数据系统(thyroid imaging reporting and data system,TI-RADS)为基础,超声误诊为甲状腺恶性病变的患者38例,共46个甲状腺结节,以手术病理镜下诊断结果对照超声声像图特征,对超声误诊病例的超声声像图特征及病理镜下表现进行回顾性分析。结果:578例甲状腺良性病变中,术前超声声像图误诊为甲状腺癌38例,误诊率为6.6%。①以甲状腺结节最大径对结节进行分组,误诊为甲状腺癌的46个甲状腺结节术前超声显示小结节组21个,最大径≤10 mm,大结节组25个,最大径10 mm,其中多数结节具有3个或3个以上恶性超声征象,表现为实性(89.1%,41/46)、囊实性(10.9%,5/46)、极低回声(87.0%,40/46)、结节边缘不规整(56.5%,26/46)和钙化(76.1%,35/46,微钙化及粗大钙化),部分结节纵横比1(30.4%,14/46)。②以甲状腺超声影像报告与数据系统(TI-RADS)为基础进行超声声像图评估,46个结节中TI-RADS评估为4c类41个(89.1%,41/46,即具有4个恶性超声征象),TI-RADS5类5个(10.9%,5/46,即具有5个恶性超声征象),无TI-RADS 1~3类结节(无恶性超声征象)。③手术病理诊断35例45个结节为结节性甲状腺肿,1例1个结节为甲状腺非典型腺瘤,2例甲状腺腺体呈弥漫性改变,无具体结节,1例为亚急性甲状腺炎,另1例为桥本甲状腺炎。38例甲状腺良性病变手术病理显示间质广泛纤维化伴玻璃样变及钙化,致超声图像复杂多样,与恶性病变难以鉴别而误诊。结论:甲状腺良性病变出现间质广泛纤维化伴玻璃样变、质硬、出血、钙化、囊性变等病理改变会使甲状腺病变形态、边界、回声强度、内部结构等出现相应改变,低回声或极低回声、边缘规整或不规整、纵横比1等良恶性征象混合存在或叠加出现时超声易误诊为甲状腺癌。
[Abstract]:Objective: to analyze the ultrasonographic features of benign thyroid lesions misdiagnosed as thyroid carcinoma by ultrasound, and to explore the causes of misdiagnosis from the pathological point of view. Methods: from December 2012 to May 2014, 578 patients with benign thyroid lesions were selected from Shanxi Cancer Hospital and confirmed by operation and pathology. Preoperative ultrasonographic diagnosis was based on thyroid imaging reporting and data system TI-RADS, 38 cases of thyroid malignancy were misdiagnosed by ultrasound, 46 thyroid nodules were diagnosed. The ultrasonographic features and pathological findings of misdiagnosed cases were analyzed retrospectively according to the diagnostic results of operation and pathology. Results in 578 cases of benign thyroid lesions, the characteristics of ultrasound were analyzed retrospectively. Thirty-eight cases of thyroid carcinoma were misdiagnosed by ultrasonography before operation, the misdiagnosis rate was 6.6.1 the largest diameter of thyroid nodules was used to group the nodules, and the 46 thyroid nodules misdiagnosed as thyroid cancer showed 21 small nodules before operation. The maximum diameter was less than 10 mm, 25 in the large nodule group and 10 mm in the maximum diameter. Most of the nodules had 3 or more malignant ultrasound signs. These are solid 89. 1 / 41 / 46, cystic / solid 10. 9 / 5 / 46, extremely low echo 87.0 / 40 / 46, irregular margin 56.526 / 46) and calcification 76. 1 / 35 / 46, micro calcification and coarse calcification, partial aspect ratio of 1 30.4 / 1 / 14 / 46 / .2 Ultrasonography based on TI-RADSs. In the 46 nodules, TI-RADS was assessed as 41 / 41 / 41 of 41 / 46, that is, there were 4 malignant ultrasound signs TI-RADS5 / 5 / 10.9 / 46, that is, there were 5 malignant ultrasound signs and no TI-RADS 1 / 3 nodules (35 cases with 45 nodules without malignant ultrasound signs). 1 case with nodular goiter and 1 case with atypical thyroid adenoma showed diffuse changes of thyroid gland in 2 cases. No specific nodule was found in 1 case of subacute thyroiditis and another case of Hashimoto's thyroiditis. 38 cases of benign thyroid lesions showed extensive interstitial fibrosis with vitreous degeneration and calcification, resulting in complicated and varied ultrasound images. Conclusion: extensive interstitial fibrosis with vitreous change, hard, hemorrhage, calcification, cystic degeneration and other pathological changes in benign thyroid lesions may lead to the morphology, boundary, echo intensity of thyroid lesions. There were corresponding changes in internal structure, hypoechoic or very low echo, irregular or irregular edges, and mixed benign and malignant signs, such as aspect ratio 1, which were easily misdiagnosed as thyroid carcinoma.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R445.1;R736.1

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