Wang Ning, Xu Yuanhong, Ge Chunlin, Guo Renxuan, Guo Kejian
General Surgery Department II, The First Affiliated Hospital, China Medical University, Shenyang 110001, People's Republic of China.
Head Neck. 2006 Dec;28(12):1077-83. doi: 10.1002/hed.20481.
Calcification can be detected in both benign and malignant nodules and is often neglected by clinical physicians. The purpose of this study was to investigate the association of thyroid nodule calcification detected on ultrasound with thyroid carcinoma.
One hundred seven cases of thyroid carcinoma and 215 cases of benign thyroid nodules were selected from the records of inpatients of our hospital who had high-resolution ultrasonography preoperatively and pathologic diagnosis postoperatively between 2001 and 2004. The case numbers and percentage of calcification, fine stippled psammomatous (FSP), and non-FSP calcification in benign nodules and thyroid carcinoma, sex, and age groups (<45 years and >or=45 years) were retrospectively reviewed. Statistical analysis was performed using chi-square test and odds ratio. Sensitivity and specificity of calcification and FSP calcification on ultrasonography were also calculated.
The incidence of calcification, non-FSP calcification, and FSP calcification were significantly higher in thyroid carcinoma than in the benign group (p < .001, p = .03, and p < .001, respectively). However, FSP calcification was more significant than the non-FSP calcification (p = .001) for predicting thyroid cancer. The incidence of non-FSP calcification and FSP calcification did not differ significantly between the sexes (p = .50 and p = .83, respectively). The relative risk of malignancy incidence was significantly higher in those younger than 45 years old with FSP calcification (p < .001). The incidence of non-FSP calcification was significantly higher in the older group (p = .03). The sensitivity of calcification and FSP calcification for the detection of malignancy was 63.55% and 24.30%, respectively; the specificity was 69.77% and 96.77%, respectively.
The detection of calcification on ultrasonography should increase the clinical index of suspicion for thyroid carcinoma and alert the physician. FSP calcification is valuable and has a very high specificity for predicting thyroid carcinoma, particularly for those younger than 45 years old or with calcified regional lymph nodes. To increase the sensitivity for the diagnosis of thyroid carcinoma, tests such as fine-needle aspiration cytology should also be performed. The use of these modalities could result in earlier detection of thyroid carcinoma. The use of ultrasound to detect calcification and FSP calcification is as efficient as thyroid papillary macrocarcinoma in predicting microcarcinoma.
钙化在良性和恶性结节中均可被检测到，常被临床医生忽视。本研究的目的是探讨超声检测到的甲状腺结节钙化与甲状腺癌之间的关联。
从我院2001年至2004年术前接受高分辨率超声检查且术后有病理诊断的住院患者记录中，选取107例甲状腺癌病例和215例良性甲状腺结节病例。回顾性分析良性结节和甲状腺癌中钙化、细点状砂粒体样（FSP）钙化和非FSP钙化的病例数及百分比、性别和年龄组（<45岁和≥45岁）。采用卡方检验和比值比进行统计分析。还计算了超声检查中钙化和FSP钙化的敏感性和特异性。
甲状腺癌中钙化、非FSP钙化和FSP钙化的发生率显著高于良性组（分别为p <.001、p =.03和p <.001）。然而，FSP钙化在预测甲状腺癌方面比非FSP钙化更显著（p =.001）。非FSP钙化和FSP钙化的发生率在性别之间无显著差异（分别为p =.50和p =.83）。45岁以下有FSP钙化者恶性肿瘤发生率的相对风险显著更高（p <.001）。非FSP钙化的发生率在老年组显著更高（p =.03）。钙化和FSP钙化检测恶性肿瘤的敏感性分别为63.55%和24.30%；特异性分别为69.77%和96.77%。
超声检查中发现钙化应提高对甲状腺癌的临床怀疑指数并提醒医生。FSP钙化对于预测甲状腺癌具有重要价值且特异性很高，尤其对于45岁以下或有钙化区域淋巴结者。为提高甲状腺癌诊断的敏感性，还应进行细针穿刺细胞学检查等检测。使用这些方法可实现甲状腺癌的早期检测。超声检测钙化和FSP钙化在预测微小癌方面与甲状腺乳头状大癌同样有效。
