甲状腺良、恶性结节的临床、超声及细胞学特征分析

目的:研究良、恶性甲状腺结节的相关临床因素、超声特征与甲状腺细针穿刺细胞学检查结果之间的关系。方法:收集2010年1月至2013年12月在上海市第一人民医院因甲状腺结节就诊,并进行超声引导下FNAB检查患者的临床资料,以FNAB细胞学诊断结果为诊断标准,分析和比较不同性质甲状腺结节患者的年龄、性别、甲状腺疾病家族史、临床症状、血清甲状腺激素、甲状腺自身抗体(TPOAb和TRAb)水平,超声检查所发现的结节数量、性状、前后径与横径比(AP/TR)、回声类型、钙化类型、边界状态、血流情况等因素,采用Logistic多因素回归,探讨这些临床和超声特征与甲状腺良、恶性结节之间的关系。结果:根据FNAB结果,1592例患者中,良性结节者1492例,恶性结节者77例,结果不确定者23例。以良性组作为对照,年龄40岁、TPOAb(+)是恶性甲状腺结节的独立危险因素(P0.05);出现钙化点、细小钙化斑、边界不规整的超声表现的恶性甲状腺的风险显著升高(P0.05)。结论:超声检查甲状腺结节出现钙化点、细小钙化斑或边界不规整等与FNAB诊断的甲状腺恶性结节之间存在明显的关联。

Analysis of the Clinical and Ultrasonic Features and Cytology Results of Fine Needle Aspiration Biopsy in Benign and Malignant Thyroid Nodules

Objective:To explore the relationship between the diagnostic outcome of fine needle aspiration biopsy and clinical factors and ultrasonic features of benign and malignant thyroid nodules.Methods:From January 2010 to December 2013, all the clinical data of patients who were diagnosed as thyroid nodules and underwented ultrasound-guided fine needle aspiration biopsy in Shanghai First People''s Hospital were collected. Based on the outcomes of fine needle aspiration biopsy which was regarded as diagnostic criteria, the clinical data of age, gender, family history of thyroid disease, clinical symptoms, thyroid function, thyrotrophin receptor antibody (TRAb) and thyroid peroxidase antibody (TPOAb) were analyzed. Ultrasonic features including size, number, composition, antero-posterior diameters/transversal diameters (AP/TR), echogenicity, calcification, margin, and grade of blood flow were also compared. To investigate the differences in clinical factors and ultrasonic features between benign and malignant thyroid nodules, multiple logistic regression analysis were used.Results:Among the 1592 patients with thyroid nodule, 1492 patients were benign nodules, 77 were malignant nodules, and 23 patients were intermediate nodules according to the outcomes of FNAB. Using benign nodules as the control group, aged less than 40 and TPOAb (+) were independent determinants of malignancy (P<0.05); the risk of malignant nodules increased when punctate calcification, microcalcifications and blurred nodular margins appearance occurred (P<0.05).Conclusion:Punctate calcification, microcalcifications and blurred nodular margins appearance occurred in nodules under ultrasound examination had remarkable correlation with the malignant thyroid nodules diagnosed by FNAB.