Clinic Analysis Of Thyroid Nodule

【Objective】To improve the veracity of the diagnosis of thyroid nodule through studying and researching the clinical characteristics and features of ultrasonogram and pathologic diagnosis in patients with thyroid nodule.【Methods】A respective study was made of 1054 patients with thyroid nodule treated in our hospital from 2005 to 2007 to summarize the features of ultrasonography and pathologic diagnosis.【Results】(1)784(74.4%)cases were diagnosed as nodular goiter,206(19.5%)as thyroid malignant tumor,53(5.0%)as follicular adenoma,6(0.6%)as chronic lymphocytic thyroiditis and 5(0.5%)as toxic nodular goiter respectively.(2)The ratio of male cases to female ones was 1 to 4.2.The average age of malignant samples was younger than that of benign samples,the difference between which was significant(P＜0.05).And there was also significant difference in the changes of onset age between man and woman.(3)24.3 percent of benign samples presents low level echo in ultrasonograms, compared with 78.6 percent of malignant samples,which was significant different. Total thyroid calcification ratio was 31.1%,which in benign samples was lower than that in malignant samples(20.9%vs.68.4%,P＜0.01).Micro-calcification ratio in benign samples was also lower than that in malignant samples(6.0%vs.51.5%, P＜0.01).Moreover the neck lymphadenectasis ratio in benign samples was lower than that in malignant samples(2.0%vs.40.8%,P＜0.05).(4)3 cases were missed in diagnosis of frozen section,as well as 41 cases were delayed-diagnosed.The histological classification of 3 missed cases was all micro-papillary thyroid carcinoma.10 of 15 delayed malignant cases were all thyroid microcancer.(5)From 1054 cases 30 thyroid microcancers were founded,of which,17 cases were diagnosed by pre-operative ultrasonographic,10 by paraffin section and 3 missed.(6)115 cases of malignant samples incorporated with nodular goiter,as well as 7 cases incorporated chronic lymphocytic thyroiditis.【Conclusions】(1)The majority of thyroid nodules were nodular goiter.Less thyroid nodules were thyroid carcinoma.And the majority of thyroid carcinoma were papillary thyroid carcinoma.(2)The patient's age and sex should be taken into account when evaluating the possibility of malignancy.Cancerous nodules are more frequent in men compared to women.And the onset age in man was older than that in woman.(3)The ultrasonographic low echo-level in nodules,calcification(especially microcalcification)and neck lymphadenectasis were maybe the specific ultrasonographic index when elevating the possibility of malignancy.(4)The reasons for misdiagnosis of ultrasonogram as follows:firstly,One patient with thyroid nodule might involve more than one type of thyroid nodular disease; secondly,different thyroid nodules could present the similar sonograms;thirdly,the sonograms had no typical tokens such as calcification,low echo-level,neck lymphadenectasis,etc.;fourthly,some of microcarcers were difficult to be found out by ultrasound.(5)The reason for misdiagnosis and delayed diagnosis of frozen section might be: first,one patient with thyroid nodule might involve more than one type of thyroid nodular disease;second,the majority of calcinomas were highly differentiated;third, there was no sufficient amount of thyroid tissue obtained from frozen section,thus it brought great difficulty to diagnose microcancer.(6)Mirocancer was possible critical cause which led to disdiagnosis and misdiagnosis in ultrasonograms and frozen section.Hence microcancer should not be neglected by clinic diagnosis.(5)There was more than one histological type of nodules in one patient with thyroid nodules,which made it more difficult on valuating the malignancy of nodules.