超声检查在甲状腺大结节成年患者中的应用价值

李艳辉; 赵晨希; 陈明; 杨爽灵; 薛现军

doi:10.16766/j.cnki.issn.1674-4152.002693

超声检查在甲状腺大结节成年患者中的应用价值

doi: 10.16766/j.cnki.issn.1674-4152.002693

1.
平顶山市平煤神马医疗集团总医院超声科，河南平顶山 467000
2.
新乡市新乡医学院三全学院，河南新乡 453003
3.
濮阳市油田总医院超声科，河南濮阳 457001

基金项目:

河南省医学科技攻关计划联合共建项目 LHGJ20191377

详细信息

通讯作者:
李艳辉，E-mail：huihuiliyanhui@126.com

中图分类号: R581R445.1
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- 被引次数: 0
出版历程
- 收稿日期: 2021-09-21
- 网络出版日期: 2022-11-30

Application value of ultrasound in adult patients with thyroid nodules ≥3 cm

1.
Department of Ultrasound, the Shenma Medical Group General Hospital of Pingdingshan City, Pingdingshan, Henan 467000, China

摘要

摘要: 目的明确≥3.0 cm甲状腺结节(TNS)和＜3.0 cm TNS的超声(US)影像差异，探讨超声在≥3.0 cm甲状腺结节患者中的应用价值。方法选择2017年3月—2019年8月在平煤神马医疗集团总医院、新乡医学院三全学院、濮阳市油田总医院进行US检查并行甲状腺手术切除的患者545例。根据甲状腺结节最大直径将患者分为大结节组(115例，152个结节)和小结节组(352例，417个结节)。大结节组为甲状腺结节≥3.0 cm的患者；小结节组为甲状腺结节＜3.0 cm的患者。对比分析甲状腺大结节与小结节患者的临床与US影像特点。结果 (1) 大结节组患者的微钙化率(28.94%)、低回声率(40.13%)、形态不规则率(13.82%)均高于小结节组患者(18.94%、7.19%、3.36%，均P < 0.05)；大结节组患者的囊性结构率(9.21%)、混合性结节率(30.26%)、高回声率(30.92%)、结节周围血管率(4.61%)均低于小结节组患者(18.94%、48.44%、42.93%、13.43%，均P < 0.05)。(2)甲状腺大结节与小结节的TI-RADS分级诊断结果比较，差异无统计学意义(P＞0.05)。(3)US检查对甲状腺大结节诊断的正确率为74.3%(113/152)。大结节是甲状腺结节恶性的危险因素(OR=2.674, 95% CI: 1.116~6.405, P=0.027)。结论 ≥3.0 cm的TNS患者US特征和＜3.0 cm的TNS患者US特征存在差异。与甲状腺小结节相比较，甲状腺大结节具有更高的恶变风险。
- 超声 /
- 甲状腺 /
- 大结节
Abstract: Objective To clarify the difference of ultrasound (US) images between ≥3.0 cm thyroid nodules (TNS) and < 3.0 cm TNS, and to explore the application value of US in patients with ≥3.0 cm thyroid nodules. Methods From March 2017 to August 2019, 545 patients underwent US examination and thyroid surgery in the Shenma Medical Group General Hospital, Sanquan College, and Oilfield General Hospital of Puyang City were selected and divided into the large nodule group (115 cases, 152 nodules) and small nodule group (352 cases, 417 nodules) according to the maximum diameter of thyroid nodules. The large nodule group comprised patients with thyroid nodules ≥ 3.0 cm, whereas patients with thyroid nodules < 3.0 cm were in the small nodule group. The clinical and US imaging features were compared between the two groups. Results (1) The microcalcification rate (28.94%), hypoechoic rate (40.13%) and irregular shape rate (13.82%) in patients with large nodules were higher than those in patients with small nodules (18.94%, 7.19% and 3.36%, respectively, all P < 0.05). The cystic structure rate (9.21%), mixed nodule rate (30.26%), hyperechoic rate (30.92%) and perinodal vascular rate (4.61%) in patients with large nodules were lower than those in patients with small nodules (18.94%, 48.44%, 42.93% and 13.43%, respectively, all P < 0.05). (2) No significant difference was found between the diagnosis results of TI-RADS classification of large thyroid nodules and small thyroid nodules (P>0.05). (3) The correct rate of US in diagnosing large thyroid nodules was 74.3% (113/152). Large nodules were the risk factors of malignant thyroid nodules (OR=2.674, 95% CI: 1.116-6.405, P=0.027). Conclusion There are differences in US characteristics between patients with TNS ≥3.0 cm and patients with TNS < 3.0 cm. Compared with small thyroid nodules, large thyroid nodules have a higher risk of malignant transformation.
- Ultrasound /
- Thyroid gland /
- Large tubercle

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图 1 甲状腺大结节典型患者的US影像

注：A为甲状腺左侧叶良性结节的US二维声像图；B为甲状腺左侧叶良性结节的彩色多普勒声像图；C为甲状腺右侧叶乳头状癌US二维声像图；D为甲状腺右侧叶乳头状癌彩色多普勒声像图。

Figure 1. US image of a typical patient with a large thyroid nodule

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表 1 2组TNS患者的社会人口学资料比较

Table 1. Comparison of sociodemographic data between two groups of patients with TNS

组别	例数	年龄(x±s，岁)	性别[例(%)]		农村户籍[例(%)]	BMI (x±s)	吸烟[例(%)]	饮酒[例(%)]	脑卒中史[例(%)]	冠心病[例(%)]	高血压[例(%)]	高血脂[例(%)]	糖尿病[例(%)]
组别	例数	年龄(x±s，岁)	男性	女性	农村户籍[例(%)]	BMI (x±s)	吸烟[例(%)]	饮酒[例(%)]	脑卒中史[例(%)]	冠心病[例(%)]	高血压[例(%)]	高血脂[例(%)]	糖尿病[例(%)]
大结节组	115	47.42±7.93	46(40.00)	69(60.00)	47(40.87)	27.82±4.51	34(29.57)	67(58.26)	2(1.74)	12(10.43)	30(26.09)	23(20.00)	17(14.78)
小结节组	352	48.02±8.05	147(41.76)	205(58.24)	149(42.33)	28.09±4.84	112(31.82)	201(57.10)	3(0.85)	34(9.66)	101(28.69)	75(21.31)	49(13.92)
统计量		0.696^a	0.111^b		0.076^b	0.528^a	0.205^b	0.048^b	0.079^b	0.059^b	0.292^b	0.089^b	0.053^b
P值		0.486	0.739		0.783	0.598	0.651	0.827	0.779	0.809	0.589	0.765	0.818
注：^a为t值，^b为χ²值。

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表 2 2组TNS患者的US影像特点比较[例(%)]

Table 2. Comparison of US imaging characteristics between two groups of patients with TNS [cases(%)]

组别	例数	结节单发	固体纹理	微钙化	低回声	形态不规则	结节形态直立性生长	囊性结构	混合性结节
大结节组	152	93(61.18)	70(46.05)	44(28.94)	61(40.13)	21(13.82)	3(1.97)	14(9.21)	46(30.26)
小结节组	417	268(64.27)	209(50.12)	79(18.94)	93(7.19)	14(3.36)	4(9.59)	79(18.94)	202(48.44)
χ²值		0.457	0.081	11.178	27.798	25.508	0.293	7.720	14.970
P值		0.499	0.777	0.001	< 0.001	< 0.001	0.588	0.005	< 0.001

组别	例数	高回声	强回声	结节内血管	结节周围血管		粗钙化	彗星尾征	海绵状外观
大结节组	152	47(30.92)	8(5.26)	23(15.13)	7(4.61)		17(11.18)	6(3.95)	8(5.26)
小结节组	417	179(42.93)	23(5.52)	64(15.35)	56(13.43)		38(9.12)	18(4.32)	22(5.28)
χ²值		6.705	0.014	0.004	8.809		0.547	0.038	< 0.001
P值		0.010	0.907	0.949	0.003		0.459	0.846	0.995

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表 3 2组TNS患者的TI-RADS分级诊断结果比较[例(%)]

Table 3. Comparison of TI-RADS classification between two groups of patients with TNS [cases(%)]

组别	例数	TI-RADS 1级	TI-RADS 2级	TI-RADS 3级	TI-RADS 4级	TI-RADS 5级	TI-RADS 6级
大结节组	152	0	9(5.92)	58(38.16)	47(30.92)	34(22.37)	4(2.63)
小结节组	417	0	22(5.28)	169(40.53)	131(31.41)	92(22.06)	3(7.19)
注：2组分级诊断结果比较，U=0.495，P=0.620。

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表 4 TNS恶性影响因素的logistic回归分析

Table 4. Logisitic regression analysis of influencing factors of TNS malignancy

变量	B	SE	Wald χ²	P值	OR值	95% CI
大结节	0.984	0.446	4.871	0.027	2.674	1.116~6.405
微钙化	0.815	0.206	15.629	< 0.001	2.259	1.508~3.384
结节含有固体成分	1.341	0.376	12.699	< 0.001	3.821	1.828~7.987
低回声	0.940	0.380	6.140	0.013	2.561	1.217~5.388
形态不规则	1.774	0.444	15.922	< 0.001	5.892	2.466~14.080
注：赋值方法如下，大结节(1=是，0=否)；微钙化(1=是，0=否)；结节含有固体成分(1=是，0=否)；低回声(1=是，0=否)；形态不规则(1=是，0=否)。

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表 5 US对甲状腺大结节的诊断效果(例)

Table 5. Diagnostic effect of US on greater thyroid nodules (cases)

病理检查	US检查		合计
病理检查	+	-	合计
+	33	2	35
-	37	80	117
合计	70	82	152

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