以超音波評估甲狀腺結節和其惡性特徵

Ultrasound Characteristics of Thyroid Nodules in Predicting Malignancy

謝宗恭(Tsung-Kung Hsieh) ； 魏培釗(Pei-Chao Wei) ； 陳穆寬(Mu-Kuan Chen)

《台灣耳鼻喉頭頸外科雜誌》 47卷3期 (2012/06) Pp. 215-221

https://doi.org/10.6286/2012.47.3.215

摘要

背景：甲狀腺超音波是評估甲狀腺結節的第一線工具，過去研究指出某些超音波特徵暗示惡性腫瘤的危險性增加，本文即欲探討可疑的甲狀腺超音波特徵與惡性甲狀腺腫瘤的相關性。方法：本研究採回溯性病例分析，蒐集2008年到2011年在彰化基督教醫院被診斷有甲狀腺結節且接受甲狀腺切除手術患者，並取得其病理報告和術前超音波報告。利用卡方檢定和多變數對數式迴歸分析，分析甲狀腺超音波特徵與惡性甲狀腺腫瘤的相關性，包括結節邊緣（margin），回音性（echogenicity），超音波結構（echostructure）和有無鈣化（calcification）。結果：共311名患者，419個甲狀腺結節，其中45個結節是甲狀腺癌（10.7％）。利用卡方檢定發現，在欲探討的超音波特徵中，只有超音波結構和有無鈣化有達統計學上的意義。超音波結構呈固體或混合的在良性和惡性結節比例分別是13.1％和35.6％，p＜.001；有鈣化在良性和惡性結節比例分別為24.9％和44.4％，p＝0.005。進一步以多變數對數式迴歸分析，只有超音波結構達統計學上意義（p＝.003），為獨立的預測因子（敏感度35.6％，陽性預測值24.6％），勝算比為3.088。結論：研究發現只有超音波下呈固體或混合結構是預測惡性腫瘤的獨立危險因子，但仍無法單獨當作診斷甲狀腺癌的標準。目前還是建議用在輔助判別是否進一步安排細針抽吸細胞學或手術上。

關鍵字

甲狀腺結節 ； 超音波 ； 惡性腫瘤

並列摘要

BACKGROUND: Background: It is well known that thyroid nodules are a common clinical problem. About 5% of which turn out to be malignancy. Therefore, early detection of malignant nodules has become the most important issue of management of thyroid nodules. Ultrasound (US) is the first-line image tool in the diagnostic evaluation of thyroid nodules. Previous studies pointed out that some ultrasound characteristics indicated increased risk for malignancy. In this article, we'll evaluate the diagnostic accuracy of ultrasound characteristics for predicting malignancy retrospectively.METHODS: From 2008 to 2011 in Changhua Christian hospital, patients with thyroid nodules who received preoperative ultrasound examination and underwent thyroidectomy were enrolled. Ultrasound characteristics to predict malignancy, including margin, echogenicity, echostructure, and calcification, were analyzed by means of χ2 test and multivariate logistic regression analysis.RESULTS: Result: A total of 311 patients with 419 nodules (374 benign nodules, 45 malignant nodules) were included. χ2 test showed that echostructure and calcification were significant US characteristics in predicting malignant nodules (p＜.05). Solid or mixed components were observed in 13.1% of benign nodules and 35.6% of malignant nodules, p＜.001. Calcifications were found in 24.9% of benign nodules and 44.4% of malignant nodules respectively, p=.005. Further analyzing with multivariate logistic regression analysis demonstrated that echostructure was the only independent ultrasound predictor for malignancy (p = .003, odd's ratio 3.088). Unfortunately, due to its low sensitivity (35.6%) and low positive predictive value (24.6%), it is not sufficient to diagnose malignant nodules by itself.CONCLUSIONS: Echostructure of solid or mixed type is the only independent risk factor for malignancy. However, it cannot be used to diagnose thyroid cancer alone. The current consensus is using combinations of US features to guide nodule selection for fine needle aspiration or surgery.

並列關鍵字

thyroid nodule ； ultrasound ； malignancy