Sonographic Characteristics of the Components of Thyroid Nodules with Histopathologic Correlation

甲狀腺結節之組織成份與其超音波影像特徵

蕭輔宗(Fu-Tsung Hsiao) ； 魏昌國(Chang-Kuo Wei) ； 陳紹哲(Shao-Jer Chen) ； 曾志恩(Jeh-En Tzeng) ； 林逸襄(Yi-Hsiang Lin) ； 徐文慶(Wen-Chin Hsu)

《中華放射線醫學雜誌》 32卷2期 (2007/06) Pp. 63-69

摘要

甲狀腺結節通常包含數種組織成份，所以在超音波影像上結節內部常呈現各種不同的回音。本研究之目的在了解甲狀腺結節內部各組織成份與其超音波影像學特徵，盼能對選擇細針抽吸之區域與區分良惡性結節有所助益。自2005年一月至2006年二月間，49位病人共75個甲狀腺結節被納入此研究。在外科手術切除前，記錄每個結節的位置、大小、與在最大切面的超音波影像；術後依照影像的切面來做病理標本的切片，並由病理科醫師來判讀。結節的各組織成份包括鈣化、被濾泡包圍的膠質體（大濾泡）、濾泡細胞、乳突狀細胞、纖維化組織、囊泡、與出血，這些組織通常是混雜出現。在超音波影像上：除了鈣化，以大濾泡為主的結節具有最高的回音﹔其次是以乳突狀細胞與濾泡細胞為主的結節；除了囊泡與出血外，纖維化組織的回音最低。在甲狀腺結節超音波影像上呈現中到低回音區域通常表示此區域包含有濾泡細胞或甚至乳突狀細胞，針對這些區域做超音波導引的細針抽吸可以得到最多的細胞學資訊。

並列摘要

Most of the thyroid nodules are heterogeneous and have various internal components, which make many radiologists and physicians confused with the various echo patterns of thyroid nodules. In the study, we want to explore the characteristic echogenicities representing the major histopathologic components of the thyroid nodules to provide information for diagnosis.
From Jan. 2005 to Feb. 2006, 49 patients with 75 thyroid nodular lesions were studied. The location and size of the nodules were recorded. Sonographic images best describing the nodule were obtained before operation. After surgical removal of the nodules, the gross specimen was examined, and slices of the targeted nodule according to the corresponding imaging plane were made. The histopathologic specimens of these thyroid nodules were reviewed by an experienced pathologist.
The major components of various thyroid nodules are calcifications, colloid with lining follicular cells (enlarged follicle), follicular cells, papillary cells, fibrosis, cysts, and hemorrhage. Most thyroid nodules have mixed components. Colloid with lining follicular cells (enlarged follicle) shows the highest echogenicity except for calcifications. Fibrosis shows the lowest echogenicity except for cyst and hemorrhage. Pure papillary or follicular cells show the echogenicity in between. Areas with intermediate and lower echo should address the possibility of follicular or papillary neoplasm. Our findings provide information for ultrasound guided aspiration.