本文選題：超聲檢查　切入點(diǎn)：誤診　出處：《山西醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:分析超聲誤診為甲狀腺癌的甲狀腺良性病變的超聲聲像圖特征,從病理角度探討其誤診原因,提高超聲對甲狀腺良性病變的診斷準(zhǔn)確率。方法:選擇2012年12月至2014年5月于山西省腫瘤醫(yī)院就診并經(jīng)手術(shù)病理證實(shí)的甲狀腺良性病變患者578例,術(shù)前超聲診斷以甲狀腺超聲影像報(bào)告數(shù)據(jù)系統(tǒng)(thyroid imaging reporting and data system,TI-RADS)為基礎(chǔ),超聲誤診為甲狀腺惡性病變的患者38例,共46個甲狀腺結(jié)節(jié),以手術(shù)病理鏡下診斷結(jié)果對照超聲聲像圖特征,對超聲誤診病例的超聲聲像圖特征及病理鏡下表現(xiàn)進(jìn)行回顧性分析。結(jié)果:578例甲狀腺良性病變中,術(shù)前超聲聲像圖誤診為甲狀腺癌38例,誤診率為6.6%。①以甲狀腺結(jié)節(jié)最大徑對結(jié)節(jié)進(jìn)行分組,誤診為甲狀腺癌的46個甲狀腺結(jié)節(jié)術(shù)前超聲顯示小結(jié)節(jié)組21個,最大徑≤10 mm,大結(jié)節(jié)組25個,最大徑10 mm,其中多數(shù)結(jié)節(jié)具有3個或3個以上惡性超聲征象,表現(xiàn)為實(shí)性(89.1%,41/46)、囊實(shí)性(10.9%,5/46)、極低回聲(87.0%,40/46)、結(jié)節(jié)邊緣不規(guī)整(56.5%,26/46)和鈣化(76.1%,35/46,微鈣化及粗大鈣化),部分結(jié)節(jié)縱橫比1(30.4%,14/46)。②以甲狀腺超聲影像報(bào)告與數(shù)據(jù)系統(tǒng)(TI-RADS)為基礎(chǔ)進(jìn)行超聲聲像圖評估,46個結(jié)節(jié)中TI-RADS評估為4c類41個(89.1%,41/46,即具有4個惡性超聲征象),TI-RADS5類5個(10.9%,5/46,即具有5個惡性超聲征象),無TI-RADS 1~3類結(jié)節(jié)(無惡性超聲征象)。③手術(shù)病理診斷35例45個結(jié)節(jié)為結(jié)節(jié)性甲狀腺腫,1例1個結(jié)節(jié)為甲狀腺非典型腺瘤,2例甲狀腺腺體呈彌漫性改變,無具體結(jié)節(jié),1例為亞急性甲狀腺炎,另1例為橋本甲狀腺炎。38例甲狀腺良性病變手術(shù)病理顯示間質(zhì)廣泛纖維化伴玻璃樣變及鈣化,致超聲圖像復(fù)雜多樣,與惡性病變難以鑒別而誤診。結(jié)論:甲狀腺良性病變出現(xiàn)間質(zhì)廣泛纖維化伴玻璃樣變、質(zhì)硬、出血、鈣化、囊性變等病理改變會使甲狀腺病變形態(tài)、邊界、回聲強(qiáng)度、內(nèi)部結(jié)構(gòu)等出現(xiàn)相應(yīng)改變,低回聲或極低回聲、邊緣規(guī)整或不規(guī)整、縱橫比1等良惡性征象混合存在或疊加出現(xiàn)時超聲易誤診為甲狀腺癌。
[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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R445.1;R736.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 蔡菁;;二維及彩色多普勒超聲對甲狀腺腫塊的診斷與鑒別診斷[J];中國超聲診斷雜志;2005年11期

2 詹維偉;徐上妍;;甲狀腺結(jié)節(jié)超聲檢查新進(jìn)展[J];中華醫(yī)學(xué)超聲雜志(電子版);2013年02期

3 ;甲狀腺結(jié)節(jié)和分化型甲狀腺癌診治指南[J];中國腫瘤臨床;2012年17期

，

本文編號：1556553