Zhu Shen-Ling, Jiang Yu-Xin, Yang Xiao, Wu Qiong, Zhao Rui-Na, Li Jian-Chu, Liu Ru-Yu, Zhang Bo
Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Translational Medicine Center of Peking Union Medical College Hospital, Beijing 100730, China.
Chin Med J (Engl). 2016 Jul 5;129(13):1533-7. doi: 10.4103/0366-6999.184460.
Some ultrasonographic (US) signs overlap between benign and malignant nodules. The purpose of this study was to raise a special US sign of benign thyroid nodules, termed the "onion skin-liked sign."
Twenty-seven patients with 27 nodules who shrank naturally and the "onion skin-liked sign" appeared on the final US images were enrolled in the study. The ultrasound characters and risk stratifications at the start and end of observation were compared. Then, thirty goiters with fibrosis and thirty papillary thyroid carcinomas (PTC) were randomly selected from the database of our hospital, matched the sizes of 27 nodules at the end point of observation. The differences of "onion skin-liked sign" between the two groups were analyzed.
The average duration of follow-up of 27 nodules was 24.0 ± 12.2 months (range, 12-65 months). At the end of the follow-up, the size of the nodules decreased on average by 1.26 ± 0.82 cm (range, 0.3-3.4 cm) and calcification was found in 21 nodules, compared with only 2 nodules with calcification at the start of the follow-up. In addition, only negligible or no blood flow signal could be detected at the periphery of all the nodules and 100% (27/27) were high suspicion at the end of observation. In matched groups, all PTC showed high suspicion of malignancy, 18/30 (60%) goiters with fibrosis were high suspicion and 11/30 (37%) were intermediate suspicion. Twenty-two patients in the group of nodular fibrosis presented "onion skin-liked sign," which was not shown in any patient of PTC group. The sensitivity, specificity, positive predictive value, and negative predictive value of "onion skin-liked sign" in predicting nodular goiter with fibrosis were 73.3%, 100%, 100%, and 78.9%, respectively.
The "onion skin-liked sign" was a characteristic US feature of benign thyroid nodules detected in the follow-up of thyroid nodules. It is useful to differentiate PTCs and nodular goiters with fibrosis.
一些超声（US）征象在良性和恶性结节之间存在重叠。本研究的目的是提出一种良性甲状腺结节的特殊超声征象，称为“洋葱皮样征”。
纳入27例有27个结节且自然缩小并在最终超声图像上出现“洋葱皮样征”的患者。比较观察开始和结束时的超声特征及风险分层。然后，从我院数据库中随机选取30例有纤维化的甲状腺肿和30例乳头状甲状腺癌（PTC），使其大小与27个结节观察终点时的大小相匹配。分析两组之间“洋葱皮样征”的差异。
27个结节的平均随访时间为24.0±12.2个月（范围12 - 65个月）。随访结束时，结节大小平均减小1.26±0.82 cm（范围0.3 - 3.4 cm），21个结节发现钙化，而随访开始时只有2个结节有钙化。此外，所有结节周边仅检测到可忽略不计或无血流信号，观察结束时100%（27/27）为高可疑。在匹配组中，所有PTC均高度怀疑为恶性，30例有纤维化的甲状腺肿中18/30（60%）为高可疑，11/30（37%）为中度可疑。结节纤维化组22例患者出现“洋葱皮样征”，PTC组无任何患者出现该征象。“洋葱皮样征”预测有纤维化的结节性甲状腺肿的敏感性、特异性、阳性预测值和阴性预测值分别为73.3%、100%、100%和78.9%。
“洋葱皮样征”是甲状腺结节随访中检测到的良性甲状腺结节的特征性超声表现。它有助于鉴别PTC和有纤维化的结节性甲状腺肿。
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