Pan Fu-shun, Wang Wei, Wang Yan, Xu Ming, Liang Jin-yu, Zheng Yan-ling, Xie Xiao-yan, Li Xiao-xi
Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (F.P., W.W., Y.W., M.X., J.L., Y.Z., X.X.), and Department of Vascular and Thyroid Surgery (X.L.), First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
J Ultrasound Med. 2015 Apr;34(4):689-96. doi: 10.7863/ultra.34.4.689.
The purpose of this study was to evaluate sonographic features for distinguishing clinically atypical subacute thyroiditis from malignant thyroid nodules.
A total of 165 hypoechoic thyroid nodules without calcification in 135 patients with histologic diagnosis were included in this study. These nodules were classified into 2 groups: a thyroiditis group (55 nodules in 36 patients) and a malignancy group (110 nodules in 99 patients). The sonographic features of the groups were retrospectively reviewed.
No significant differences were detected for the variables of marked echogenicity, a taller-than-wide shape, and mixed vascularity. However, a poorly defined margin was detected more frequently in the thyroiditis group than the malignancy group (P < .05); it yielded a high capability for differential diagnosis of atypical subacute thyroiditis, with sensitivity and specificity of 87.3% and 80.9%, respectively. Centripetal reduction echogenicity was observed exclusively in the thyroiditis group, with high specificity (100%) but low sensitivity (21.8%) for atypical subacute thyroiditis diagnosis. All of the thyroiditis nodules with a positive color signal showed noninternal vascularity (negative predictive value, 100%).
There is a considerable overlap between the sonographic features of atypical subacute thyroiditis and thyroid malignancy. However, the margin, echogenicity, and vascularity type are helpful indicators for differential diagnosis of atypical subacute thyroiditis.
本研究旨在评估超声特征，以鉴别临床非典型亚急性甲状腺炎与甲状腺恶性结节。
本研究纳入了135例经组织学诊断的患者中165个无钙化的低回声甲状腺结节。这些结节分为两组：甲状腺炎组（36例患者中的55个结节）和恶性肿瘤组（99例患者中的110个结节）。对两组的超声特征进行回顾性分析。
在显著回声性、纵横比大于1的形态及混合性血管等变量方面未检测到显著差异。然而，甲状腺炎组边界不清的情况比恶性肿瘤组更常见（P <.05）；其对非典型亚急性甲状腺炎具有较高的鉴别诊断能力，敏感性和特异性分别为87.3%和80.9%。向心性回声减低仅在甲状腺炎组中观察到，对非典型亚急性甲状腺炎诊断具有高特异性（100%）但低敏感性（21.8%）。所有彩色信号阳性的甲状腺炎结节均显示无内部血管（阴性预测值为100%）。
非典型亚急性甲状腺炎与甲状腺恶性肿瘤的超声特征有相当程度的重叠。然而，边界、回声性及血管类型是鉴别非典型亚急性甲状腺炎的有用指标。
