Ha Eun Ju, Baek Jung Hwan, Lee Jeong Hyun, Lee Ha Young, Song Dong Eun, Kim Jae Kyun, Shong Young Kee, Hong Suck Joon
Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Acta Radiol. 2015 Jul;56(7):814-9. doi: 10.1177/0284185114539322. Epub 2014 Jun 17.
A marked hypoechogenicity is a reliable criterion for a malignant nodule, whereas isoechogenicity is considered to be a benign ultrasonographic (US) finding. However, there have been no reports to demonstrate whether a focal marked hypoechogenicity within an isoechoic nodule is a focal malignancy.
To evaluate whether a focal marked hypoechogenicity within an isoechoic nodule on US examination is a focal malignancy and to correlate US histologic findings using surgical or core needle biopsy (CNB) specimens.
From January 2010 to August 2011, 28 consecutive patients (25 women, 3 men; mean age, 52.2 years) with 29 thyroid nodules, which showed a focal marked hypoechogenicity within an isoechoic nodule on US, underwent US-guided CNB for a suspicion of a focal malignancy. All nodules were confirmed by surgery (n = 6) or more than two consecutive US-guided biopsies (n = 23). We evaluated the risk of malignancy, and analyzed histological components which correlated with a focal marked hypoechogenic area within an isoechoic nodule on US. Statistical analysis was performed using the Mann-Whitney U test and Fisher's exact test.
Of the 29 nodules, 25 were benign (86.2%) and four were malignant (13.8%). The peripheral location of focal marked hypoechogenicity within an isoechoic nodule was the only significant US finding that suggested malignancy (P = 0.03). All benign focal marked hypoechogenicities were histologically composed of severe fibrosis with a few follicular cells with varying frequencies of hemosiderin, calcification, infarction, and granulation tissue.
Although a focal marked hypoechogenicity within an isoechoic nodule is usually benign, the peripheral location of a focal marked hypoechogenicity may be a malignancy. The histologic information obtained by CNB specimen may reduce the needs for repetitive fine needle aspirations or diagnostic surgery.
显著低回声是恶性结节的可靠标准，而异回声被认为是良性超声（US）表现。然而，尚无报道表明等回声结节内的局灶性显著低回声是否为局灶性恶性病变。
评估超声检查时等回声结节内的局灶性显著低回声是否为局灶性恶性病变，并将超声检查结果与手术或粗针活检（CNB）标本的组织学结果相关联。
2010年1月至2011年8月，连续28例患者（25例女性，3例男性；平均年龄52.2岁），共29个甲状腺结节，超声检查显示等回声结节内有局灶性显著低回声，因怀疑局灶性恶性病变而接受超声引导下CNB。所有结节均经手术（n = 6）或连续两次以上超声引导下活检（n = 23）确诊。我们评估了恶性风险，并分析了与超声检查时等回声结节内局灶性显著低回声区域相关的组织学成分。采用Mann-Whitney U检验和Fisher精确检验进行统计分析。
29个结节中，25个为良性（86.2%），4个为恶性（13.8%）。等回声结节内局灶性显著低回声的外周位置是提示恶性病变的唯一显著超声表现（P = 0.03）。所有良性局灶性显著低回声在组织学上均由严重纤维化组成，伴有少量滤泡细胞，含铁血黄素、钙化、梗死和肉芽组织的出现频率各异。
尽管等回声结节内的局灶性显著低回声通常为良性，但局灶性显著低回声的外周位置可能为恶性病变。通过CNB标本获得的组织学信息可能会减少重复细针穿刺或诊断性手术的需求。
