中国普外基础与临床杂志

中国普外基础与临床杂志

TI-RADS 4 类甲状腺良性结节的超声声像图特征与病理特征分析

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目的 总结甲状腺影像报告和数据系统(TI-RADS)4 类甲状腺良性结节的超声声像图特征及病理学特征。 方法 回顾性分析 2016 年 6 月至 2017 年 6 月期间于南京中医药大学附属医院行超声检查示 TI-RADS 4 类的 46 例甲状腺良性结节患者、共计 52 个结节的术前超声声像图特征及术后病理学特征。 结果 52 个 TI-RADS 4 类结节中,4A 类 32 个(61.54%),4B 类 12 个(23.08%),4C 类 8 个(15.38%);超声声像图主要表现为低回声(90.38%,47/52)、实性或实性为主(98.08%,51/52)、直径>1 cm(61.54%,32/52)、边界欠/不清(36.54%,19/52)、微钙化(50.00%,26/52)、较丰富/点条状血流(65.38%,33/52)、规则形态(90.38%,47/52)、纵横比≤1(92.31%,48/52)及无可疑淋巴结(86.54%,45/52)。术后病理学检查提示结节性甲状腺肿伴纤维化/钙化 20 个(38.46%),结节性甲状腺肿伴腺瘤形成 16 个(30.77%),结节性甲状腺肿 5 个(9.62%),桥本甲状腺炎 9 个(17.31%),甲状腺滤泡性腺瘤 2 个(3.85%)。 结论 结节性甲状腺肿(伴纤维化/钙化或伴腺瘤形成)、桥本甲状腺炎以及甲状腺滤泡性腺瘤行超声检查时可具有甲状腺癌的声像图特征,临床需结合其他检查方法进行综合评估。

Objective To summarize the ultrasonographic and pathological features of benign thyroid nodules in thyroid imaging reporting and data system (TI-RADS) 4 class. Methods The preoperative ultrasonographic features and pathological features of 46 patients (52 nodules) with TI-RADS 4 class benign thyroid nodules who got treatment in Affiliated Hospital of Nanjing University of Traditional Chinese Medicine between June 2016 and June 2017 were retrospectively analyzed. Results Among the 52 thyroid nodules, 32 nodules (61.54%) were categorized as TI-RADS 4A, 12 nodules (23.08%) were categorized as TI-RADS 4B, and 8 nodules (15.38%)were categorized as TI-RADS 4C. On ultrasonographic images, the 52 thyroid nodules showed hypoechogenicity (90.38%, 47/52), solid or predominantly solid (98.08%, 51/52), nodules>1 cm in diameter (61.54%, 32/52), ill-defined margin (36.54%, 19/52), microcalcification (50.00%, 26/52), abundant or pointy blood flow (65.38%, 33/52), morphological rule (90.38%, 47/52), aspect ratio≤1 (92.31%, 48/52), and no suspicious lymph nodes (86.54%, 45/52). On histology, these thyroid nodules revealed nodular goiter with fibrosis or calcification (38.46%, 20/52), nodular goiter with adenoma (30.77%, 16/52), nodular goiter (9.62%, 5/52), Hashimoto’s thyroiditis (17.31%, 9/52), and thyroid follicular adenoma (3.85%, 2/52). Conclusion Nodular goiter (thyroid nodules with fibrosis, calcification or adenomatoid hyperplasia), Hashimoto’s thyroiditis, and thyroid follicular adenoma will lead to malignant signs on ultrasonographic images, we should refer to other examination methods to make combination evaluation.

关键词: 甲状腺良性结节; 甲状腺影像报告和数据系统 4 类; 超声; 病理学检查

Key words: benign thyroid nodule; thyroid imaging reporting and data system 4 class; ultrasound; pathological examination

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