Varverakis Emmanuel, Neonakis Evaggelos, Tzardi Maria, Chrysos Emmanuel
Endocrinology and Metabolism Center of Chania, Chania (Crete), Greece.
Hormones (Athens). 2007 Jan-Mar;6(1):44-51.
To evaluate the application of color flow Doppler (CFD) sonography in the preoperative management of benign and malignant cold thyroid nodules.
Eighty-five patients with a cold thyroid nodule larger than 1cm were examined with CFD sonography prior to thyroidectomy. The histological examination revealed that 18 (21%) patients had malignant nodules and 67 (79%) had benign ones. The sonographic characteristics of the nodules used for evaluation were: a) absence of vascularization, b) presence of peripheral vascularization, c) presence of central vascularization and d) size of the nodule. The correlations between the pre-operative sonographic characteristics, as defined above, and the histological findings of the nodules were determined. results: The results showed that the vascular signals were absent in 4/18 (22%) of malignant nodules and 16/67 (23%) of benign ones. The smaller nodules (<2.5 cm.) were more frequently avascular (15/37=40%) compared to the larger ones (5/48=10%) (p<0.05). Moreover, for the nodules with vascularization, the peripheral distribution of vascularization was more frequently encountered in benign nodules (p<0.01 specificity=0.77, sensitivity=0.46), while central vascularization was more frequent in malignant ones (p<0.01, specificity=0.70, sensitivity=0.66). Thus, absence of vascularization in a nodule does not exclude the probability of malignancy, since vascularization depends on the size rather than the histological features of the nodule. Furthermore, for the vascularized nodules, peripheral distribution of vascularization is a characteristic of benignancy with high specificity, while central distribution is a characteristic of malignancy with medium specificity.
CFD sonography contributes to the differential diagnosis of the large vascularized nodules, but it is less helpful in the smaller non-vascularized ones.
评估彩色多普勒（CFD）超声检查在甲状腺良恶性冷结节术前管理中的应用。
85例甲状腺冷结节直径大于1cm的患者在甲状腺切除术前接受CFD超声检查。组织学检查显示，18例（21%）患者为恶性结节，67例（79%）为良性结节。用于评估的结节超声特征为：a）无血管化，b）周边血管化，c）中央血管化，d）结节大小。确定上述术前超声特征与结节组织学结果之间的相关性。结果：结果显示，4/18（22%）的恶性结节和16/67（23%）的良性结节无血管信号。较小的结节（<2.5cm）相比更大的结节（5/48=10%）更常无血管（15/37=40%）（p<0.05）。此外，对于有血管化的结节，良性结节中血管化周边分布更为常见（p<0.01，特异性=0.77，敏感性=0.46），而恶性结节中中央血管化更为常见（p<0.01，特异性=0.70，敏感性=0.66）。因此，结节无血管化并不排除恶性的可能性，因为血管化取决于结节大小而非组织学特征。此外，对于有血管化的结节，血管化周边分布是良性的高特异性特征，而中央分布是恶性的中等特异性特征。
CFD超声有助于大血管化结节的鉴别诊断，但对较小的无血管化结节帮助较小。
