Yunus Mahira, Ahmed Zeba
Department of Radiology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
J Pak Med Assoc. 2010 Oct;60(10):848-53.
The purpose of this study was to provide sonographic and colour flow criteria helpful for differentiation between benign and malignant solid thyroid nodules.
This prospective study was carried out at Sindh Institute of Urology and Transplantation (SIUT), Karachi Pakistan from 01.05.07 to 31.12.08. Sonographic scans of 78 thyroid nodules in 66 patients were performed and characteristics of thyroid nodules that were studied included microcalcifications, an irregular or microlobulated margins, marked hypoechogenicity, a shape that was taller than it was wide and color flow pattern in Color Doppler ultrasound. The presence and absence of characteristics of nodules were classified as having positive or negative findings. If even one of these sonographic features was present, the nodule was classified as positive (malignant). If a nodule had none of the features described, it was classified as negative (benign). The final diagnosis of a lesion as benign (n = 53) or malignant (n = 25) was confirmed by fine needle aspiration biopsy, and patients who were proved to have benign lesions were followed-up for 6 months and malignant lesions which were proved on histopathology after FNA were subjected to surgery. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were then calculated on the basis of our proposed classification method.
Among 78 solid thyroid nodules 35 lesions were classified as positive considering the sonographic characteristics and 23 of them were proved to be malignant on histopatology. Out of 43 lesions which were classified as negative, 2 were proved to be malignant. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy based on our sonographic classification method were 93.8%, 66%, 56.1%, 95.9%, and 74.8%, respectively.
Ultrasound is valuable for identifying many malignant or potentially malignant thyroid nodules. No single ultrasound criterion is reliable in differentiating all benign from malignant thyroid nodules, but many US features aid in predicting the benign or malignant nature of a given nodule. Fine-needle aspiration biopsy should be performed on thyroid nodules classified as positive, regardless of palpability.
本研究旨在提供有助于鉴别甲状腺实性结节良恶性的超声及彩色血流标准。
本前瞻性研究于2007年5月1日至2008年12月31日在巴基斯坦卡拉奇的信德泌尿与移植研究所（SIUT）开展。对66例患者的78个甲状腺结节进行了超声扫描，所研究的甲状腺结节特征包括微钙化、边界不规则或呈微分叶状、显著低回声、纵横比大于1以及彩色多普勒超声中的血流模式。结节特征的有无被分类为有阳性或阴性结果。如果这些超声特征中哪怕仅出现一项，该结节即被分类为阳性（恶性）。如果一个结节没有所述的任何特征，则被分类为阴性（良性）。通过细针穿刺活检确认病变为良性（n = 53）或恶性（n = 25），被证实为良性病变的患者随访6个月，FNA后经组织病理学证实为恶性病变的患者接受手术。然后根据我们提出的分类方法计算敏感性、特异性、阳性预测值、阴性预测值和准确性。
在78个甲状腺实性结节中，根据超声特征，35个病变被分类为阳性，其中23个在组织病理学上被证实为恶性。在43个被分类为阴性的病变中，2个被证实为恶性。基于我们的超声分类方法，敏感性、特异性、阳性预测值、阴性预测值和准确性分别为93.8%、66%、56.1%、95.9%和74.8%。
超声对于识别许多恶性或潜在恶性甲状腺结节具有重要价值。没有单一的超声标准能够可靠地鉴别所有甲状腺良性与恶性结节，但许多超声特征有助于预测特定结节的良恶性。无论是否可触及，对于分类为阳性的甲状腺结节均应进行细针穿刺活检。
