-
-
表 1 预示恶性甲状腺结节超声特征的敏感性和特异性(%) [9]
超声特征 敏感性(范围) 特异性(范围) 低回声 53. 4 (26. 5~ 87. 1) 73. 2 (43. 4~ 94. 3) 微钙化 42. 3 (29. 0~ 59. 2) 91. 2 (85. 5~ 95. 0) 不规则边界 57. 7 (47. 8~ 77. 5) 85.1 (74. 3~ 95. 3) 纵横比>1 58. 1 (32. 7~ 83. 6) 81. 4 (60. 0~ 92. 5) 缺乏晕 63. 6 (32. 5~ 88. 9) 61. 2 (22. 2~ 80. 0) 多普勒信号增多 77. 2 (56. 7~ 92. 3) 79. 3 (34. 7~ 97. 4) 表 2 甲状腺结节的FNA超声指征[8]及推荐级别
甲状腺结节的FNA超声指征 推荐级别 高危人群5~ 9mm结节具有可疑超声特征 A 不正常的颈部淋巴结 A ≥1c m的结节具有微钙化 B ≥1c m实性低回声结节 B ≥1~ 1. 5c m实性和等回声或高回声结节 B ≥1. 5~ 2. 0cm混合囊性/实性结节具有可疑的超声特征 B ≥2c m囊性为主或海绵样结节无可疑超声特征 C A:证据明确, 强烈推荐; B:证据中等, 推荐; C:专家推荐 -
[1] Davies L, Welch HG.Increasing incidence of thyroid cancer in the United States, 1973-2002 [J].JAMA, 2006, 295: 2164-2167. doi: 10.1001/jama.295.18.2164 [2] Papini E, Guglielimi R, Bianchini A, et al.Risk of malignancy in nonpalpable thyroid nodules: predictive value to ultrasound and color-Doppler features [J].J Clin Endocrinol Metab, 2002, 87:1941-1946. doi: 10.1210/jcem.87.5.8504 [3] Koike E, Noguchi S, Yamashita H, et al.Utrasonogrphic characteristics of thyroid nodules:prediction of malignancy [J].Arch Surg, 2001, 136:334-337. doi: 10.1001/archsurg.136.3.334 [4] Okamoto T, Yamashita I, Harasawa A, et al.Test performances of three diagnostic procedures in evaluating thyroid nodules:physical examination, ultrasonogrphy and fine needle aspiration cytology[J].Endocr J, 1994, 41:243-247. doi: 10.1507/endocrj.41.243 [5] Jun Peter, Chow LC, Jeffrey RB, et al.Pictorial essay:the sonographic features of papillary thyroid carcinomas[J]. Ultrasound Q, 2005, 21:39. http://europepmc.org/abstract/MED/15716757 [6] Zhang B, Jiang YX, Liu JB, et al.Utility of Contrast-enhanced ultrasound for evaluation of thyroid nodules[J]. Thyroid, 2010, 20, 51-57. doi: 10.1089/thy.2009.0045 [7] Rago T, Santini F, Scutari M, et al.Elastography:new developments in ultrasound for predicting malignancy in thyroid nodules[J].J Clin Endocrinol Metab, 2007, 92:2917- 2922. doi: 10.1210/jc.2007-0641 [8] Cooper DS, Doherty GM, Haugen BR, et al.Revised American Thyroid Association Management Guidelines for patients with thyroid nodules and differentiated thyroid cancer [J].Thyroid, 2009, 19:1167-1264. doi: 10.1089/thy.2009.0110 [9] Sipos JA.Advances in ultrasound for the diagnosis and management of thyroid cancer[J].Thyroid, 2009, 19:1365- 1372. http://www.ncbi.nlm.nih.gov/pubmed/20001718 [10] Frates MC, Benson CB, Doubilet PM, et al.Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography[J].J Clin Endocrinol Metab, 2006, 91:3411-3417. doi: 10.1210/jc.2006-0690 [11] Moon WJ, Jung SL, Lee JH, et al.Benign and malignant thyroid nodules:US differentiation-multicenter retrospective study[J].Radiology, 2008, 247:762-770. doi: 10.1148/radiol.2473070944 [12] 张波, 姜玉新, 戴晴, 等.甲状腺结节灰阶和彩色多普勒超声特征的Logistic回归分析[J].中华超声影像学杂志, 2008, 17:1061-1065. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhcsyx200812014 [13] Alexander EK, Marqusee E, Orcutt J, et al.Thyroid nodule shape and prediction of malignancy[J].Thyroid, 2004, 14:953-958. doi: 10.1089/thy.2004.14.953 [14] Ahuja AT.Practical head and neck ultrasound [M].London:Greenwieh Medical Media Limited, 2000:35-63. [15] Reading CC, Charboneau JW, Hay ID, et al.Sonography of thyroid nodules:a" classic pattern" diagnostic approach [J].Ultrasound Q, 2005, 21:157-165. doi: 10.1097/01.ruq.0000174750.27010.68 [16] Kim BM, Kim MJ, Kim EK, et al.Sonographic differentiation of thyroid nodules with eggshell calcifications[J].J Ultrasound Med, 2008, 27:1425-1430. doi: 10.7863/jum.2008.27.10.1425 [17] Frates MC, Benson CB, Charboneau JW, et al.Management of thyroid nodules detected at US Socitety of Radiologists in Ultrasound consensus conference statement[J]. Radiology, 2005, 237:794-800. doi: 10.1148/radiol.2373050220 [18] Stulak JM, Grant CS, Farley DR, et al.Value of preoperative ultrasonography in the surgical management of initialand reoperative papillary thyroid cancer[J].Arch Surg, 2006, 141:489-494. doi: 10.1001/archsurg.141.5.489 [19] Bonnet S, Hartl D, Leboulleux S, et al.Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment[J].J Clin Endocrinol Metab, 2009, 94:1162-1167. doi: 10.1210/jc.2008-1931 [20] Giard RW, Hermans J.Use and accuracy of fine-needle aspiration cytology in histologically proven thyroid carcinoma: an audit using a national pathology database[J].Cancer, 2000, 90:330-334. doi: 10.1002/1097-0142(20001225)90:6<330::AID-CNCR2>3.0.CO;2-T [21] Yang J, Schnadig V, Logrono R, et al.Fine-needle aspiration of thyroid nodules:a study of 4703 patients with histologic and clinical correlations[J].Cancer, 2007, 111: 306-315. doi: 10.1002/cncr.22955 [22] Asteria C, Giovanardi A, Pizzocaro A, et al.US-elastography in the differential diagnosis of benign and malignant thyroid nodules[J].Thyroid, 2008, 18:523-531. doi: 10.1089/thy.2007.0323 [23] Kim BM, Kim MJ, Kim EK, et al.Controlling recurrent papillary thyroid carcinoma in the neck by ultrasonographyguided percutaneous ethanol injection [J]. EurRadiol, 2008, 18:835-842. doi: 10.1007/s00330-007-0809-5 [24] Lewis BD, Hay ID, Charboneau JW, et al.Percutaneous ethanol injection for treatment of cervical lymph nodemetastases in patients with papillarythy roid carcinoma[J]. AJR, 2002, 178:699-704. doi: 10.2214/ajr.178.3.1780699 [25] Monchik JM, Donatini G, Iannuccilli J, et al.Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma[J].Ann Surg, 2006, 244:296-304. doi: 10.1097/01.sla.0000217685.85467.2d