【摘要】：目的 應(yīng)用彩色多普勒超聲儀觀(guān)察甲狀腺良惡性結(jié)節(jié)的圖像特征,結(jié)合病理形態(tài)學(xué)診斷,探討甲狀腺良惡性結(jié)節(jié)的超聲表現(xiàn)與病理學(xué)的關(guān)系及相關(guān)意義,進(jìn)而提高甲狀腺惡性結(jié)節(jié)的超聲診斷符合率。方法 選取110例(125個(gè))甲狀腺結(jié)節(jié)做研究對(duì)象,所有病例均行彩色多普勒超聲和彩色多普勒超聲檢查,且均經(jīng)手術(shù)病理證實(shí)診斷。其中33例(39個(gè)結(jié)節(jié))惡性結(jié)節(jié),同期選取77例(86個(gè)結(jié)節(jié))良性結(jié)節(jié)。通過(guò)觀(guān)察彩色多普勒超聲和多普勒超聲對(duì)125個(gè)甲狀腺結(jié)節(jié)所呈現(xiàn)的圖像特征,統(tǒng)計(jì)各超聲圖像對(duì)甲狀腺惡性結(jié)節(jié)的診斷敏感度和特異度,比較各超聲圖像對(duì)甲狀腺結(jié)節(jié)良惡性鑒別的意義；比對(duì)分析這33例(39個(gè)結(jié)節(jié))惡性結(jié)節(jié)的HE病理切片,提供病理形態(tài)學(xué)依據(jù)。結(jié)果 甲狀腺惡性結(jié)節(jié)與結(jié)節(jié)的多發(fā)或單發(fā)無(wú)明顯關(guān)系。甲狀腺惡性結(jié)節(jié)彩色多普勒超聲圖像顯示：實(shí)性結(jié)節(jié)(100%)、邊界模糊(76.90%)、形態(tài)不規(guī)則(59.00%)、周邊無(wú)暈環(huán)(92.30%)、回聲不均(94.90%)、低回聲(94.90%),內(nèi)部見(jiàn)微鈣化(69.20%),頸部淋巴結(jié)腫大(41.00%)；多普勒超聲顯示以?xún)?nèi)部血流信號(hào)為主(74.40%)。各超聲圖像對(duì)甲狀腺結(jié)節(jié)的良惡性診斷均提示有統(tǒng)計(jì)學(xué)意義(P0.05)。甲狀腺惡性結(jié)節(jié)病理切片顯示：切面呈灰白色,質(zhì)地堅(jiān)硬；低倍鏡下顯示形態(tài)多不規(guī)則(22/39),邊界多模糊(30/39),纖維假包膜(10/39)；砂粒體數(shù)目多≥5個(gè)/HP(26/39),病灶內(nèi)組織由癌細(xì)胞(分為濾泡狀和乳頭狀兩種)和纖維間質(zhì)組成。不同的病灶,組織細(xì)胞所占的比例也有所不同；纖維間質(zhì)均有程度不等的玻璃樣變；癌細(xì)胞與纖維間質(zhì)呈帶狀排列或交錯(cuò)排列。結(jié)論 1超聲影像檢查對(duì)甲狀腺結(jié)節(jié)檢出率高。二維超聲及彩色多普勒超聲表現(xiàn)有助于甲狀腺結(jié)節(jié)性質(zhì)的判斷。 2甲狀腺結(jié)節(jié)表現(xiàn)為：形態(tài)不規(guī)則、邊界模糊、內(nèi)部低回聲伴有微小鈣化灶、頸部淋巴結(jié)腫大并且聲像異常則惡性病變可能性增大。 3甲狀腺惡性結(jié)節(jié)的超聲表現(xiàn)及彩色多普勒特點(diǎn)與病理學(xué)分型密切相關(guān)。
[Abstract]:Objective to observe the image features of benign and malignant thyroid nodules by color Doppler ultrasound, and to explore the relationship between ultrasonic findings and pathology of benign and malignant thyroid nodules and its significance combined with pathomorphological diagnosis. Thus, the coincidence rate of ultrasonic diagnosis of malignant thyroid nodules was improved. Methods 110 cases (125 thyroid nodules) were studied. All cases were examined by color Doppler ultrasound and color Doppler ultrasound, and all of them were confirmed by operation and pathology. Among them, 33 cases (39 nodules) were malignant nodules, 77 cases (86 nodules) benign nodules were selected at the same time. By observing the imaging features of 125 thyroid nodules by color Doppler ultrasound and Doppler ultrasound, the sensitivity and specificity of each ultrasound image in the diagnosis of thyroid malignant nodules were counted. To compare the significance of ultrasound images in the differential diagnosis of benign and malignant thyroid nodules. The HE pathological sections of 33 cases (39 nodules) of malignant nodules were compared and analyzed to provide pathomorphological basis. Results there was no significant relationship between malignant thyroid nodules and multiple or single nodules. Color Doppler ultrasound images of malignant thyroid nodules showed solid nodules (100%), blurred boundaries (76.90%), irregular morphology (59.00%), no halo ring around (92.30%) and uneven echo (94.90%). Hypoechoic (94.90%), microcalcification (6920%) and cervical lymph node enlargement (41.00%). Doppler ultrasound showed the main internal blood flow signal (74.40%). All ultrasound images showed statistical significance in the diagnosis of benign and malignant thyroid nodules (P 0.05). The pathological sections of malignant thyroid nodules showed that the section was grayish white and hard, the shape was irregular (22 鈮，

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