探讨超声检查对甲状腺结节鉴别诊断的价值
发布时间：2019-06-07 11:44
【摘要】：背景 甲状腺结节（Thyroid Nodular, TN）是甲状腺局部腺体在硬度、结构发生异常改变的组织。在内分泌系统中,甲状腺结节是一种多发病和常见病。通过体格检查甲状腺触诊可获得甲状腺结节患病率为3%~7%。通过高清晰度B超检查其患病率为19%~67%。通过尸检甲状腺结节发现率高达50%以上。甲状腺结节多数为良性病变，因此绝大多数甲状腺结节只需定期复查，可减少不必要的甲状腺手术和手术带来的并发症。而甲状腺癌则应尽快治疗，最大程度改善其预后。因此甲状腺结节良、恶性鉴别是诊断的首要问题。以便尽早地发现甲状腺癌并及时给予相应治疗。随着诊断技术的发展，先进诊断工具的应用，如18F-FDGPET、三维超声、PET成像、基因检测等，提供了甲状腺结节鉴别诊断的新方法。在诊断甲状腺结节过程中，超声检查因其无创伤、方便快捷、无放射性、费用低廉等特点，大大提高了患者的依从性，目前仍是首选方法。 目的 通过分析甲状腺结节患者的超声检查结果、病理检查结果。从而探讨超声检查对甲状腺结节鉴别诊断的临床价值。 对象与方法 收集2010年1月至2013年1月之间在郑州大学第二附属医院普外科因甲状腺结节接受手术治疗的628例患者的临床资料、超声检查结果、术后病理检查结果，进行回顾性分析。年龄分布为14～85岁，平均48.05±13.50岁，男性129例，女性499例，男：女为0.26:1。患者术前均接受高分辨率超声检查、彩色多普勒超声检查和甲状腺实时组织弹性成像检查。收集超声结果中甲状腺结节的数目、回声、周界是否清楚、边缘是否规则、包膜是否完整、结节周围有无声晕、结节内部有无钙化、结节血流情况及弹性评分。根据术后病理检查结果，建立二分类Logistic模型。应用SPSS13.0软件分析鉴别诊断甲状腺结节的超声征象价值。 结果 选取甲状腺结节的数目、回声、周界是否清楚、边缘是否规则、包膜是否完整、结节周围有无声晕、结节内部有无钙化、血流情况及弹性评分进行χ2检验，结果示结节的数目（P＞0.05）没有统计学意义，其余超声征象均有统计学意义（P＜0.05）。建立Logistic回归模型后，筛选出弹性评分≥3分、边缘不规则、结节内部钙化灶、低回声、包膜不完整是对鉴别甲状腺结节良、恶性有价值的超声征象。其中弹性评分≥3分（OR=20.892，r=2.873，P=0.000）、低回声结节（OR=12.533，r=2.296，P=0.000）、结节边缘不规则（OR=19.494，r=2.570，P=0.000）、结节内钙化灶（OR=14.421， r=2.351， P=0.001）、包膜不完整（OR=3.861，r=1.351， P=0.009）作为自变量进入Logistic回归回归方程：Logit(P)=0.783＋1.351×包膜＋2.570×边缘＋2.296×回声＋2.351钙化＋2.873×弹性评分。该回归模型进行似然比检验。结果为χ2=168.112，，P=0.000（P＜0.05）。其模型有统计学意义。绘制ROC曲线，曲线下面积为AUZ0.812。 结论 1.甲状腺结节的数目对鉴别甲状腺结节良、恶性没有价值。 2.结节周界、声晕、周边血流情况鉴别甲状腺结节良、恶性价值较低。而结节弹性评分、边缘是否规则、结节内钙化灶情况、回声、结节包膜的鉴别诊断价值较大。 3.其诊断价值从大到小为弹性评分＞边缘不规则＞结节内钙化灶＞低回声＞包膜不完整。
[Abstract]:background The thyroid nodule (TN) is a group of thyroid local glands with abnormal changes in hardness and structure. In the endocrine system, thyroid nodule is a kind of multi-morbidity and common The prevalence of thyroid nodules can be found to be 3% ~ 7 by physical examination of thyroid palpation %. The prevalence of high-definition B-ultrasound is 19% ~ 67 %. The rate of discovery of thyroid nodules by necropsy was as high as 50%. The majority of the thyroid nodules are benign, so the vast majority of the thyroid nodules need to be regularly reviewed to reduce the complications associated with unnecessary thyroid surgery and surgery. The thyroid cancer should be treated as soon as possible, and its pre-treatment should be improved to the maximum extent. After that, it is the primary question of the diagnosis of benign and malignant thyroid nodules. In order to find thyroid cancer as early as possible and to give the corresponding treatment in a timely manner With the development of diagnostic technology, the application of advanced diagnostic tools, such as 18F-FDGPT, 3D ultrasound, PET imaging, gene detection and so on, provides a new prescription for the differential diagnosis of thyroid nodules. in that proces of the diagnosis of the thyroid nodule, the ultrasonic examination greatly improves the compliance of the patient because of the characteristics of no trauma, convenience and quickness, no radioactivity, low cost and the like, Law. Objective To analyze the results of ultrasonography in patients with thyroid nodules and their disease. To study the results of the examination of thyroid nodules by means of ultrasonic examination. Clinical value Methods: The clinical data, the results of the ultrasonic examination and the postoperative pathological examination were collected between January 2010 and January 2013 between January 2010 and January 2013 at the second affiliated hospital of Zhengzhou University. The age distribution ranged from 14 to 85 years, with an average of 48.05 to 13.50, a male of 129, a female of 499, and a male. : The female was 0.26:1. The patients received high-resolution ultrasound, color Doppler ultrasound and thyroid imaging before the operation. The elastic imaging of the tissue was examined. The number of thyroid nodules in the ultrasound was collected, the echo, the perimeter was clear, the edges were regular, the envelope was intact, there was a silent halo around the nodule, and there were calcifications and nodules in the nodules. Blood flow condition and elastic score. According to the results of postoperative pathological examination, a two-class L was established. Logistic model and application of SPSS13.0 software for differential diagnosis of thyroid nodule The results were as follows: the number of thyroid nodules, the echo, whether the perimeter is clear, whether the edge is regular, whether the envelope is complete, there is a silent halo around the node, and there is no calcification or blood flow inside the nodule. The results showed that the number of nodules (P> 0.05) was not of statistical significance and the other ultrasound signs were all. Statistical significance (P <0.05). After the logistic regression model was established, the score of elastic score was 3, the edge was irregular, the inside of the nodule was calcified, and the low echo and the envelope were incomplete. The score of elastic score was 3 (OR = 20.892, r = 2.873, P = 0.000), low echo nodule (OR = 12.533, r = 2.296, P = 0.000), the edge of the node was irregular (OR = 19.494, r = 2.570, P = 0.000), the calcification in the nodule (OR = 14.421, r = 2.351, P = 0.001), the envelope was incomplete (OR = 3.861, r = 1.351, P = 0.009) as the independent variable to enter L. Logistic regression equation: Logit (P) = 0.783 + 1.351 envelope + 2.570 + edge + 2.296 + echo + 2.351 Calcification + 2.873 elastic score . The regression model is used for likelihood ratio test. The result is[2 = 拢112, P = 0.000(P锛
本文编号：2494768
[Abstract]:background The thyroid nodule (TN) is a group of thyroid local glands with abnormal changes in hardness and structure. In the endocrine system, thyroid nodule is a kind of multi-morbidity and common The prevalence of thyroid nodules can be found to be 3% ~ 7 by physical examination of thyroid palpation %. The prevalence of high-definition B-ultrasound is 19% ~ 67 %. The rate of discovery of thyroid nodules by necropsy was as high as 50%. The majority of the thyroid nodules are benign, so the vast majority of the thyroid nodules need to be regularly reviewed to reduce the complications associated with unnecessary thyroid surgery and surgery. The thyroid cancer should be treated as soon as possible, and its pre-treatment should be improved to the maximum extent. After that, it is the primary question of the diagnosis of benign and malignant thyroid nodules. In order to find thyroid cancer as early as possible and to give the corresponding treatment in a timely manner With the development of diagnostic technology, the application of advanced diagnostic tools, such as 18F-FDGPT, 3D ultrasound, PET imaging, gene detection and so on, provides a new prescription for the differential diagnosis of thyroid nodules. in that proces of the diagnosis of the thyroid nodule, the ultrasonic examination greatly improves the compliance of the patient because of the characteristics of no trauma, convenience and quickness, no radioactivity, low cost and the like, Law. Objective To analyze the results of ultrasonography in patients with thyroid nodules and their disease. To study the results of the examination of thyroid nodules by means of ultrasonic examination. Clinical value Methods: The clinical data, the results of the ultrasonic examination and the postoperative pathological examination were collected between January 2010 and January 2013 between January 2010 and January 2013 at the second affiliated hospital of Zhengzhou University. The age distribution ranged from 14 to 85 years, with an average of 48.05 to 13.50, a male of 129, a female of 499, and a male. : The female was 0.26:1. The patients received high-resolution ultrasound, color Doppler ultrasound and thyroid imaging before the operation. The elastic imaging of the tissue was examined. The number of thyroid nodules in the ultrasound was collected, the echo, the perimeter was clear, the edges were regular, the envelope was intact, there was a silent halo around the nodule, and there were calcifications and nodules in the nodules. Blood flow condition and elastic score. According to the results of postoperative pathological examination, a two-class L was established. Logistic model and application of SPSS13.0 software for differential diagnosis of thyroid nodule The results were as follows: the number of thyroid nodules, the echo, whether the perimeter is clear, whether the edge is regular, whether the envelope is complete, there is a silent halo around the node, and there is no calcification or blood flow inside the nodule. The results showed that the number of nodules (P> 0.05) was not of statistical significance and the other ultrasound signs were all. Statistical significance (P <0.05). After the logistic regression model was established, the score of elastic score was 3, the edge was irregular, the inside of the nodule was calcified, and the low echo and the envelope were incomplete. The score of elastic score was 3 (OR = 20.892, r = 2.873, P = 0.000), low echo nodule (OR = 12.533, r = 2.296, P = 0.000), the edge of the node was irregular (OR = 19.494, r = 2.570, P = 0.000), the calcification in the nodule (OR = 14.421, r = 2.351, P = 0.001), the envelope was incomplete (OR = 3.861, r = 1.351, P = 0.009) as the independent variable to enter L. Logistic regression equation: Logit (P) = 0.783 + 1.351 envelope + 2.570 + edge + 2.296 + echo + 2.351 Calcification + 2.873 elastic score . The regression model is used for likelihood ratio test. The result is[2 = 拢112, P = 0.000(P锛
本文编号：2494768
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