【摘要】 目的 探讨彩色多普勒超声对临床甲状腺良恶性结节的诊断价值。 方法 对2007-2010年105例经手术病理证实的甲状腺结节患者资料进行回顾性分析，总结其声像图特征。 结果 105例患者中，良性结节71例，甲状腺癌34例，超声诊断符合率81.9%，误诊18例（17.1%）。 结论 彩色多普勒超声是诊断甲状腺结节的首选影像学检查方法，但对良恶性结节的鉴别及微小癌的诊断有局限性。【Abstract】 Objective To evaluate the value of color Doppler flow imaging in diagnosis of benign and malignant thyroid nodules. Methods We retrospectively analyzed the clinical data of 105 patients with thyroid nodules confirmed by pathology between 2007 and 2010 and summarized the ultrasonography results. Results Among the 105 cases, 71 were benign nodules and 34 were malignant tumors. The overall diagnostic accordance rate was 81.9% with 18 cases (17.1%) of misdiagnosis. Conclusion Ultrasonography is the first imaging modality for thyroid nodule examination, but it is limited in the diagnosis of microcarcinoma and in distinguishing malignant from benign nodules in the same thyroid.
摘要:目的:采用Meta分析的方法评价甲状腺球蛋白在甲状腺良性疾病和甲状腺癌中的临床意义。方法:通过检索MEDLINE、EMBASE、The Cochrane Library, 中国生物医学文献数据库、中国学术期刊全文数据库和其他方式广泛收集文献。根据QUADAS质量评价标准评价纳入文献的质量,用MetaDisc软件对其敏感度、特异度、阳性似然比、阴性似然比等进行合并分析,并进行异质性检验,绘制综合受试者工作特征曲线(summary receiver operator characteristic curve,SROC)。结果:最终纳入5篇文献。合并敏感度0.60,合并特异度0.83,合并比值比2.68, SROC下面积(AUC)=0.645 4。结论:现有研究证实:甲状腺球蛋白在甲状腺癌中的阳性率是甲状腺良性疾病中的2.68倍,有统计学差异,但敏感度不高。尚需更多设计严谨、科学的临床试验进一步证实。Abstract: Objective: To evaluate the quality of the current studies involving the value of serum thyroglobulin in the diagnosis of thyroid benign diseases and thyroid carcinoma. Methods: We comprehensive collected current studies about serum thyroglobulin in thyroid benign diseases and thyroid carcinoma by computer and manual searches. QUADAS items were used for quality assessment in our systematic review. Metadisc software was used to analyze pooled sensitivity, pooled specificity,pooled positive likelihood ratio and pooled negative likelihood ratio,pooled diagnostic test odds ratio and heterogeneity test,and draw summary receiver operator characteristic curve (SROC). Results: Totally 5 studies were included. To identify thyroid benign diseases and thyroid carcinoma, pooled sensitivity was 0.60, pooled specificity was 0.83,pooled odds ratio was 2.68, the area under curve (AUC) was 0.645 4.Conclusion: The results of statistic alanalysis showed that the positive rate of thyroglobulin in thyroid carcinoma is 2.68 times more than in benign thyroid diseases. There was significant difference. But sensitivity was not high and reporting quality of the studies was relatively poor. The conclusion still need more clinical trials to confirm.
Objective To evaluate the clinical value of elasticity indicators in differential diagnosis of thyroid nodules. Methods Gray-scale ultrasound and elasticity imaging were used to examine 116 thyroid nodules. The rate of diameter change and ratio of area in the elasticity and gray-scale imaging were calculated and compared with pathology. Results In nodules of the ultrasonic elasticity grade 4 level and above, the proportion of malignant nodules was significanty higher than that of benign thyroid nodules （P＜0.05）. The malignant nodules was significanty higher than benign thyroid nodules in the rate of diameter change and ratio of area in the elasticity and gray-scale imaging （P＜0.05）. According to ROC analysis, the value of diagnosis and the diagnostic accuracy of the ratio of area was superior to that of the rate of diameter change （P＜0.05）. Conclusion As diagnostic indicators for differential diagnosis of thyroid nodules, the rate of diameter change and the ratio of area in elasticity can significantly improve the value of diagnosis and the accuracy of differential diagnosis level of thyroid nodules.
Objective To further strengthen the understanding of the genesis of thyroid tumors through the analysis of thyroid nodules in the clonal origin. Method The related literatures which discussed the clonality of thyroid nodules were reviewed and analyzed. Results About the clonal origin of thyroid nodules， the X chromosome inactivation detection and single gene mutation detection were the most widely chosen one at present. Most of the materials available at present related to X chromosome inactivation proposed that major part of the thyroid nodules were monoclonal and the malignant cells spreaded by means of the inner lymphatic vessel net，whereas polyclonal and monoclonal thyroid nodules coexisted occasionally. Only BRAF mutation was found of certain importance in clonal origin identification in the thyroid nodules. Conclusions Thyroid nodule is prevalent in clinical practice，while the clonality of thyroid nodules especially the thyroid tumor is not clear. And for the time being the commonly used methods to identify the clonal origin of thyroid nodule are X chromosome inactivation and single gene mutation detection. Published results confirm the finding of X chromosome inactivation methods that the majority of thyroid nodules are monoclonally originated.
ObjectiveTo explore the value of ultrasound-guided core needle biopsy (CNB) in diagnosis of thyroid nodules. MethodsThe clinical data of 347 patients with thyroid nodules who underwent ultrasoundguided CNB were retrospectively analyzed, and the results of CNB pathology were compared with postoperative wax pathology results. ResultsAll patients completed CNB successfully and satisfaction rate for tissue samples was 100%. After CNB, local hematoma occurred in two cases and relieved by conservative therapy. The CNB pathology results of 347 cases of patients were as follows: 117 cases were malignancy, including papillary thyroid cancer in 115 cases, undifferentiated adenocarcinoma in 1 case, and squamous cell carcinoma in 1 case; 230 cases were benign, including thyroiditis in 53 cases, and nodular goiter in 141 cases, adenoma in 16 cases, and nodular goitre coexisting thyroiditis in 20 cases. In 132 cases of patients underwent surgery including 113 cases of malignancy and 19 cases of benign disease, the CNB pathology results in 127 cases were consistent with postoperative wax pathology results and false negative occurred in 5 cases. The diameter of thyroid nodules were not more than 0.5 cm in 4 cases, 0.5-1.0 cm in 59 cases, 1-2 cm in 46 cases, and more than 2 cm in 23 cases, and the accuracy rate of CNB pathology results was 75.0%（3/4）, 98.3%（58/59）, 97.8%（45/46）, and 91.3%（21/23）, respectively, which was the highest in 0.5-2.0 cm. The accuracy, sensibility, specificity, positive predictive value, negative predictive value, failure rate, and misdiagnosis rate of ultrasound-guided CNB for differential diagnosis of thyroid malignant nodules from benign nodules were 96.21% (127/132), 95.76% (113/118), 100% (14/14), 1 (113/113), 0.74 (14/19), 4.24%(5/118), and 0 (0/14), respectively. ConclusionUltrasound-guided CNB has important value on differential diagnosis of thyroid nodules, and important guiding significance on treatment of thyroid diseases.
ObjectiveTo investigate the clinical value of real-time elastosonography in diagnosis of thyroid nodules. MethodsThe clinical date of 168 patients with thyroid nodules, admitted to our hospital from June 2009 to December, were retrospectively analyzed with pathological findings as the reference standard． The findings on elastography were classified into five grades: grade 0 to Ⅳ. The nodules with grade less than Ⅱ were diagnosed as benign, otherwise more than Ⅲ were diagnosed as malignancy. ResultsThere were 208 nodules in 168 patients: nodular goiter was in 125 cases, thyroid adenoma in 36 cases, thyroid malignant tumor in 41 cases including 39 cases for thyroid papillary carcinoma, 1 case for thyroid medullary carcinoma, 1 case for thyroid non-Hodgkin lymphoma. Other nodules were in 6 cases, including diffuse toxic goiter in 1 case, local lymphocytic thyroiditis in 3 cases, and subacute granulomatous thyroiditis in 2 cases. There were 148 thyroid nodules in grade 0-Ⅱ and 60 nodules in grade Ⅲ-Ⅳ. According to the pathological findings, 97.3%(144/148) thyroid nodules of grade 0-Ⅱ were benign, however, 38.3% (23/60) of grade Ⅲ-Ⅳ were benign. Furthermore, 2.7% (4/148) thyroid nodules of grade 0-Ⅱ were malignancy, while 61.7% (37/60) of grade Ⅲ-Ⅳ were malignancy. The sensitivity， specificity, and accuracy of the real-time elastosonography in diagnosis of thyroid nodules was 90.2%(37/41), 86.2%(144/167), and 87.0%(181/208), respectively. ConclusionReal-time elastosonography can reflect the relative hardness of thyroid nodules and provide useful information for diagnosis, which is helpful in differentiating benign and malignant thyroid nodules.