The incidence of thyroid diseases are higher at home and abroad, with the most common nodular goiter, it was reported in the literature, of which 4% -17% of patients with thyroid cancer, but because of the lack of coexistence between history and clinical signs , the low rate of preoperative diagnosis. JIANG Hong Chuan reported 20 cases of preoperative no one cases were diagnosed, Zhu Xian reported 68 cases for preoperative diagnosis of malignant and 18 suspicious cases, the diagnosis was only 26.4 percent. Currently high-frequency ultrasound and color Doppler technology applications, although the merger of nodular goiter in the diagnosis of thyroid cancer have some help, but it is difficult to find cancer characterized. In recent years the extensive launching of fine-needle aspiration cytology, although higher thyroid diseaseæ‹…the preoperative diagnostic accuracy of the technology but there are some false positive and false negative possible. Have reported in the literature of the false positive rate in the 3% - 5%, the occurrence of false-negative rate of 2% - 19% is the main reason needle small cell samples provided inadequate or no puncture from the lesion site, and the limitations of the cytology itself, as some well-differentiated carcinoma only based on histological diagnosis. 1981 Isler, such as first reported improved needle and needle puncture technique can be used histological specimens, opened up a fine needle biopsy in clinical applications, will be fine-needle aspiration cytology diagnosis by pushing to a high degree of histological diagnosis. But the operation more complicated technologies, drawing inadequate, were easily broken, requiring considerable experience in the production of technical limitations of pathology at the grassroots level in all hospitals difficult. Ultrasound-guided biopsy is an advanced automatic biopsy technology, introduced in China in 1991, the paper automatically using ultrasound-guided biopsy whole cutting process only 0.1 s, and real-time ultrasound under control in the biopsy needle accurately grasp the depth of and perspective, not hurt the surrounding organs and blood vessels, admitted organizations are less breakable, tissue can fully meet the needs of pathological diagnosis and, thus security, high rate of diagnosis.In this paper, the use of Philips (IU22) color Doppler ultrasound diagnostic apparatus (the probe frequency of 7.5-17 MHz). Biopsy of the U.S. insurance company BAND automatic biopsy gun (16 G trough organizations cutting needle, ejection from the 15 mm-22mm). Since December 2005 to December 2007 to 110 cases confirmed by surgery and pathology of nodular goiter patients (including 15 patients with thyroid cancer) in the preoperative in color Doppler ultrasound-guided, to thyroid biopsy, Biopsy results will be pathological examination and surgery and pathology results were compared.Preoperative preparation are as follows:(1) Puncture before wellness checks (including blood, blood coagulation time, ECG)(2) Multi-section of thyroid ultrasound scanning to a comprehensive understanding of nodular location, size, shape, internal echo, echo the rear, the surrounding organs and blood vessels course, choose the best needle aspiration points and direction. Used for guided puncture strengthened 2% glutaraldehyde disinfectant solution for 2 h immersion.(3) To the preoperative patients and the families of patients with biopsy explain possible complications, and the signature file. In particular account of the blood vessels in the neck, nerve injury may be, so as to avoid unnecessary disputes. Puncture method(1) Measurements:Patients supine position, fully exposed neck of the anterior Dianqi Department probe light home, direct scanning. By using two-dimensional ultrasound observation thyroid nodules shape, size, internal echo, the nodules do to puncture the largest vertical and horizontal scanning, measurement of diameter (L) and short tracks (S), and then using color Doppler flow imaging (CDFI), color Doppler energy (CDPI) observation internal and peripheral blood flow, marking the puncture point.(2) Puncture:
With shoulder high, head-over- stretching, skin conventional disinfection of the area, shop-sterile towels to show lesions in ultrasound images is the middle, in a probe correct 0.5-2.0 cm in the open side with 1% lidocaine local Anesthesia. Color Doppler ultrasound probe coupled with filling of sterile gloves enveloping, 14 G needles in a puncture prick holes, 18 G organizations cutting needle probe scanning plane along the needle, the needle bar parallel to the surface of the probe in real-time super - Acoustic monitoring the slow advance through nodules under the edge of open insurance, stimulate biopsy gun, "gunshots" immediately after Needle, the Organization of the tank will be cut 10% of the Fuk Add Ermalin of internal fixation. Cutting needle probe Road in the lesions observed in the location of the lesions, left needle-echo reflection. Sterile gauze local oppression about 5-10 minutes to prevent hematoma formation. 2-3 times a single nodule based examination pathology. Multiple nodules greater choice, unclear border, flu-like gravel surface, ultrasonic flow rich nodule aspiration biopsy, to the extent possible choice for more than two lesions based. Multiple nodular and diffuse nodular type cases, select border unclear, the internal echo uneven, the rear echo attenuation, in a kind of calcium tablets or less-generation CDFI showed internal flow rich in cancer nodule aspiration biopsy suspicious, Deep glands on the face and edge of the vertical nodules should be cautiously uses the needle to avoid through the thyroid gland, damage adjacent organs and the surrounding tissue. Biopsy, at least one based organization of the envelope containing nodules, facilitate pathological diagnosis. 2-3 h after review ultrasound to detect whether complications occurred.110 patients, of the former multi-line section of thyroid ultrasound scanning, two-dimensional image on the careful observation of thyroid overall shape, echo and echo change, measuring the size and thyroid lesions District clumps size, on the basis of this superposition Color Doppler signal to observe the overall situation and local blood flow in clumps. A comprehensive understanding of the nodule location, size, shape, internal echo, echo the rear, the surrounding organs and blood vessels running situation. 110 cases of thyroid patients⑴simple enlargement of 15 cases, of which five cases of thyroid echo uniform, uneven 10 cases, the internal blood flow than those in rich blood flow faster;⑵nodular goiter with 61 cases, the nodules diameter Less than 2 cm, and more hair, scattered distribution. Hypoechoic nodules echo for the 52 cases, such as echo, echo-nodules nine cases, the nodules more clearly the border, a form of rules, internal echo uneven 46 cases, 15 cases of internal echo uniform; visible part of the surrounding hypoechoic halo of 31 cases ; Nodules, no significant blood flow of 36 cases, blood visible light signal 25 cases; thyroid substance in the blood flow more than the rich.⑶thyroid mass with calcification of the more than 34 cases, of which three cases of cystic masses, nine cases of solid mass, mass mixture of 19 cases, calcification three cases; clumps, no blood flow in 19 cases, clumps around This shows that, short-term blood-nine cases, clumps seen in six cases of blood flow. Clumps form are owed to the rules, but the boundary more clearly, more coated incomplete, internal echo uneven, with some strong echoes that point Flake and irregular strong echo of segregation. This article nodular goiter of the high-frequency ultrasound imaging performance plans for: thyroid irregular grow up, not coated formation, the real uniformity of poor, rough echo in real terms, seen in single or multiple nodules, clumps, Nodules or clumps in the echo more uneven, with more of the mixture, nodules or clumps border clearly, shape the rules, for more than clumps wall thickness ranging from clumps in the mixture of no more than to echo with the mesh Echo-and-distribution, with more than a single or multiple irregular distribution of strong echoes with acoustic shadow. Its flow is: clumps of the real situation with its rich blood flow fibrosis related to the early flow rich, advanced flow sparse; nodules, clumps or have no blood flow signals, or no more than around only see sparse , Linear flow signals. 110 cases of nodular goiter patients of which five cases before the ultrasound diagnosis of nodular goiter with thyroid cancer, thyroid cancer has the following typical performance Ultrasonography:①a low echo [32];②owed to the border rules, no Envelope;③there are small calcifications;④rear echo attenuation;⑤neck visible swelling of the lymph nodes.⑥color Doppler ultrasound performance: CDFI show glands scattered within a small branch-and-blood flow signals, with normal thyroid blood flow than the fold, no significant increase. Some nodules with a small amount of low blood flow. Some nodules, no blood, liquefaction of nodules have no blood visible, no circular flow nodules edge. Thyroid artery diameter normal or mildly widened, PW flow spectrum Vmax normal or slightly higher, slightly wider band. After the disappearance of low systolic and diastolic volatility can be increased.110 cases of patients with all Chuanla biopsy success, the success rate of 100%, with no apparent complications, the average per lesion sampling 3-4 needles, up to eight injections, at least three injections, received the Organization of the length of about 0.5-2 cm range, A width of 0.8 mm, a small core of living, material satisfaction. Biopsy diagnosis of nodular goiter with thyroid cancer in 13 cases, pathological return after the merger of nodular goiter 15 cases of thyroid cancer, ultrasound diagnosis and surgery and pathology rate was 33.3 %. Biopsy pathology and surgical pathology rate was 86.7 percent, misuse (leak) rate was up 13.3%. Results Show List:Nodular goiter with thyroid cancer biopsy and surgical pathology TableAdoption of this study showed that: Ultrasound-guided biopsy based high success rate (this group of about 100%), biopsy specimens of good quality and high rate of histologic diagnosis, histologic diagnosis with a high rate (86.7% of this group). Since the technology is based fast, high accuracy, security, and easy to operate, and other advantages of the early lesion diagnosis and differential diagnosis is of great significance to increase the overall level of clinical diagnosis. |
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