Haber R S
Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
Endocr Pract. 2000 Sep-Oct;6(5):396-400. doi: 10.4158/EP.6.5.396.
To review the role of ultrasonography in the detection and management of thyroid cancer.
Viewpoints are presented on the appropriate applications and the advantages of ultrasonography, based on an extensive personal experience with more than 1,500 ultrasound examinations for assessment of thyroid nodules and for follow-up surveillance of patients with thyroid cancer.
Ultrasonography is ideal for thyroid imaging because of the high echogenicity of thyroid tissue, the superficial site of the thyroid that allows the use of high-frequency transducers yielding high resolution, and the low expense compared with other techniques. In patients with a thyroid nodule, ultrasonography can assist in distinguishing benign from malignant disease. Ultrasound studies will characterize the presence of cystic versus solid elements, the degree of echogenicity of solid elements, the existence of calcifications, and the regularity and definition of the nodule borders. Although individual sonographic features of thyroid nodules are not specific for benign or malignant lesions, a constellation of typical features has more diagnostic value. Hypoechogenicity, poorly defined irregular margins, and microcalcifications are characteristics that should increase the index of suspicion for a malignant nodule. Cytologic examination of fine-needle aspirates is the optimal diagnostic test, and ultrasonographic guidance for performance of the aspiration biopsy is often helpful and sometimes critical. Ultrasonography is also useful for detection of cervical lymph node metastatic lesions. Lymph nodes involved with metastatic thyroid cancer tend to become rounded and bulging, and they lose their hilar echoes as their structure becomes disrupted.
Because of its high resolution and relatively reasonable cost, ultrasonography is valuable in the diagnosis and management of thyroid cancer.
综述超声检查在甲状腺癌检测及管理中的作用。
基于超过1500例用于评估甲状腺结节及对甲状腺癌患者进行随访监测的超声检查的丰富个人经验，阐述超声检查的恰当应用及优势。
由于甲状腺组织的高回声性、甲状腺位于浅表部位可使用高频探头获得高分辨率图像以及与其他技术相比费用较低，超声检查是甲状腺成像的理想方法。对于有甲状腺结节的患者，超声检查有助于鉴别良性与恶性疾病。超声检查可确定结节内囊性与实性成分的存在、实性成分的回声程度、钙化的存在情况以及结节边界的规则性和清晰度。虽然甲状腺结节的个别超声特征对良性或恶性病变并无特异性，但一系列典型特征具有更高的诊断价值。低回声、边界不清且不规则以及微钙化是应增加对恶性结节怀疑指数的特征。细针穿刺抽吸物的细胞学检查是最佳诊断测试，超声引导下进行穿刺活检通常很有帮助，有时甚至至关重要。超声检查对于检测颈部淋巴结转移病变也很有用。发生甲状腺癌转移的淋巴结往往会变圆且隆起，随着其结构被破坏，会失去其门部回声。
由于其高分辨率和相对合理的成本，超声检查在甲状腺癌的诊断和管理中具有重要价值。
