甲狀腺微小乳頭狀癌超聲診斷與病理特點(diǎn)的對(duì)比分析

周春蘭+聞華+賀燕美

摘要：目的 探討甲狀腺微小乳頭狀癌的高頻超聲特征，同時(shí)對(duì)比超聲和病理診斷甲狀腺微小乳頭狀癌的符合率。方法 回顧分析本院2012年1月～2016年1月術(shù)后病理確診的26例甲狀腺微小乳頭狀癌患者的超聲診斷表現(xiàn)，并將超聲與病理診斷結(jié)果進(jìn)行比對(duì)分析。結(jié)果 26例患者中，術(shù)前超聲檢查提示為甲狀腺微小乳頭狀癌為22例，超聲診斷符合率84.60%。其中I型血流2例，Ⅱ型血流2例，Ⅲ型血流18例；22例縱橫比 （L/T）≥1；誤診為結(jié)節(jié)性甲狀腺腫3例，橋本氏病1例。結(jié)論 不同的病理特征的甲狀腺微小乳頭癌決定了不同的超聲圖像，高頻超聲診斷甲狀腺微小乳頭癌準(zhǔn)確率較高、操作方便、費(fèi)用低等優(yōu)點(diǎn)，腫塊縱橫比和血流特點(diǎn)有較高的特異性。

關(guān)鍵詞：甲狀腺微小乳頭狀癌；超聲；病理

Abstract：Objective To investigate the ultrasound characteristics of thyroid papillary microcarcinoma，compared with ultrasound and pathological diagnosis of papillary thyroid microcarcinoma coincidence rate.Methods The ultrasonographic findings of 26 patients with thyroid papillary carcinoma diagnosed by postoperative pathology from January 2012 to January 2016 were analyzed retrospectively，and ultrasound diagnosis and pathology results were compared and analyzed.Results In 26 patients，preoperative ultrasound examination showed papillary thyroid carcinoma in 22 cases，the coincidence rate of ultrasound diagnosis of 84.60%.2 cases of type I blood flow，2 cases of type Ⅱ blood flow，type Ⅲ blood flow in 18 cases；22 cases of aspect ratio（L/T）≥1；misdiagnosed as nodular goiter in 3 cases，Hashimoto's disease in 1 case.Conclusion Different thyroid papillae with different pathological features determine different ultrasound images.High frequency ultrasonography has the advantages of high accuracy，easy operation and low cost of thyroid papillary carcinoma.The aspect ratio of tumor and the characteristics of blood flow are higher specificity.

Key words：Papillary thyroid microcarcinoma；Ultrasonography；Pathology

甲狀腺微小乳頭狀癌（papillary thyroid microcarcinoma）是甲狀腺惡性腫瘤中的常見類型，具有發(fā)生隱匿、進(jìn)展緩慢、惡性程度低等特點(diǎn)，臨床上容易漏診、誤診[1]。早期診斷并及時(shí)手術(shù)可達(dá)到根治的效果[2]。和良性腫塊相比CT值及磁共振TW加權(quán)的分辨率差別較小而診斷困難，大多數(shù)需要經(jīng)細(xì)針穿刺病理學(xué)檢查才能確診，但細(xì)針穿刺檢查操作復(fù)雜，且存在“針道播散”的風(fēng)險(xiǎn)[3]。近年來(lái)，高頻超聲已經(jīng)成為甲狀腺疾病的主要檢查方法[4]。筆者通過(guò)對(duì)比分析本院2012年1月～2016年1月術(shù)后病理確診的26例甲狀腺微小乳頭狀癌患者的超聲診斷表現(xiàn)，探討甲狀腺微小乳頭狀癌的高頻超聲特征，對(duì)比超聲和病理診斷甲狀腺微小乳頭狀癌的符合率。……