甲状腺微小乳头状癌的超声特征与甲状腺外侵犯假阴性、假阳性的相关因素分析

临床普外科电子杂志 ›› 2022, Vol. 10 ›› Issue (3): 41-.

甲状腺微小乳头状癌的超声特征与甲状腺外侵犯假阴性、假阳性的相关因素分析

1. 陆军军医大学大坪医院全科医学科，重庆 400042；2. 陆军军医大学大坪医院超声诊断科，重庆 400042

出版日期:2022-07-01 发布日期:2022-10-21

Ultrasonic features of papillary thyroid microcarcinoma and related factors of false negative and false positive extrathyroid invasion

1. General Medicine Department of Daping Hospital, Army Medical University, Chongqing 400042, China; 2. Ultrasound Department of Daping Hospital, Army Medical University, Chongqing 400042, China

Online:2022-07-01 Published:2022-10-21

摘要/Abstract

摘要：

目的分析甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC) 的超声特征与甲状腺外侵犯假阴性、假阳性的相关因素。方法选取2019 年10 月至2021 年9 月陆军军医大学大坪医院收治的70例疑似PTMC 患者，对其开展超声检查。以术后病理诊断为依据，观察PTMC 的超声特征，评估PTMC中甲状腺外侵犯的价值，并对出现假阴性及假阳性的影响因素进行分析。结果 PTMC 的超声特征表现为病灶直径≤ 1cm、形态不规则、边界不清晰、纵横比≥ 1、血流分级Ⅰ～Ⅱ级、囊变实性、实性部分低回声以及无声晕、钙化。70 例病例中，病理诊断检出PTMC 69 例，超声诊断PTMC 的敏感度97.1%、特异度100.0%、准确性97.1%，与病理诊断比较无显著差异（P ＜ 0.05）。69 例确诊PTMC 病例中，病理诊断检出甲状腺外侵犯29 例，超声诊断的敏感度58.6%、特异度75.0%、准确性73.9%，与病理诊断比较差异有显著性（P ＞ 0.05）；PTMC 无甲状腺外侵犯病例的真阴性与假阳性病例在病灶直径方面有显著差异，假阳性直径在5mm 以上的比例更高（P ＜ 0.05）；PTMC 甲状腺外侵犯病例的真阳性与假阴性病例在病灶直

径方面差异显著，假阴性直径≤ 5mm 的比例更高（P ＜ 0.05）；假阴性病灶纵横比≥ 1 的比例更高（P ＜ 0.05）；假阴性邻近气管比例更低（P ＜ 0.05）；假阴性双侧叶病变的比例更低（P ＜ 0.05）。结论超声诊断PTMC敏感性、特异性及准确性高。在对PTMC 甲状腺外侵犯的诊断过程中，病灶直径＞ 5mm 是导致假阳性的主要原因，病灶直径≤ 5mm、病灶纵横比≥ 1、邻近气管、双侧叶病变是导致假阴性的主要原因。在超声诊断PTMC 过程中，对上述因素进行深入分析，能够降低甲状腺外侵犯漏诊及误诊率，为手术治疗提供可靠的依据。

关键词: 甲状腺微小乳头状癌, 超声特征, 甲状腺外侵犯, 假阴性, 假阳性, 相关因素

Abstract:

Objective To analyze the ultrasonic features of papillary thyroid microcarcinoma (PTMC) and the related factors of false negative and false positive extrathyroid invasion. Method 70 patients with suspected PTMC admitted to Daping Hospital of the Army Medical University from October 2019 to September 2021 were selected for ultrasound examination. Based on the postoperative pathological diagnosis, the ultrasonic characteristics of PTMC were observed, the value of extrathyroid invasion in PTMC was evaluated, and the influencing factors of false negative and false positive were analyzed. Result The ultrasonic features of PTMC were as follows: lesion diameter ≤ 1cm, irregular shape, unclear boundary, aspect ratio ≥ 1, blood flow grade Ⅰ ～ Ⅱ , cystic

consolidation, hypoechoic solid part, silent halo and calcification. In 70 cases, 69 cases of PTMC were detected by pathological diagnosis. The sensitivity, specificity and accuracy of ultrasonic diagnosis of PTMC were 97.1%, 100.0% and 97.1% respectively. There was no significant difference compared with pathological diagnosis (P＞ 0.05). Among 69 cases of PTMC, 29 cases of extrathyroid invasion were detected by pathological diagnosis. The sensitivity, specificity and accuracy of ultrasonic diagnosis were 58.6%, 75.0% and 73.9%, respectively, with significant difference compared with pathological diagnosis (P ＜ 0.05); the true negative and false positive cases of PTMC without extrathyroid invasion had significant difference in lesion diameter, and the proportion of false positive diameter above 5mm was higher (P ＜ 0.05); the true positive and false negative cases of PTMC extrathyroid invasion had significant difference in lesion diameter, and the proportion of false negative diameter

≤ 5mm was higher (P ＜ 0.05); The proportion of false negative lesions with aspect ratio ≥ 1 was higher (P＜ 0.05); The proportion of false negative adjacent trachea was lower (P ＜ 0.05); The proportion of false negative bilateral lobe lesions was lower (P ＜ 0.05). Conclusion Ultrasound has high sensitivity, specificity and accuracy in the diagnosis of PTMC. In the diagnosis of extrathyroid invasion of PTMC, the main cause of false positive was the diameter of lesion > 5mm, the diameter of lesion ≤ 5mm, the aspect ratio of lesion ≥ 1, adjacent trachea and bilateral lobe lesions. In the process of ultrasonic diagnosis of PTMC, in-depth analysis of the above factors can reduce the missed diagnosis and misdiagnosis rate of extrathyroid invasion, and provide a reliable basis for surgical treatment.

Key words: Papillary thyroid microcarcinoma, Ultrasonic characteristics, Extrathyroid invasion, False negative, False positive, Related factors

赵兴燕, 胡加银. 甲状腺微小乳头状癌的超声特征与甲状腺外侵犯假阴性、假阳性的相关因素分析 [J]. 临床普外科电子杂志, 2022, 10(3): 41-.

ZHAO Xingyan, HU Jiayin. Ultrasonic features of papillary thyroid microcarcinoma and related factors of false negative and false positive extrathyroid invasion [J]. Journal of General Surgery for Clinicians, 2022, 10(3): 41-.