Analysis Of Ultrasonic Characteristics Of Thyroid Carcinoma And The Calcification Sign

BACKGROUNDThyroid carcinoma is one kind of the most common malignant tumor, and is acommon tumor of endocrinal tumor and account for1~2%of the whole body’s malignanttumor.5~10%of the thyroid nodule incidentally found by ultrasound is malignant. Inrecent years, the domestically occurring incidence of papillary thyroid carcinoma isclimbing gradually. So to differentiate the benignity and the malignancy of the thyroidnodules becomes a very important issue in clinical practice. Several kinds of exams can bepracticed to help diagnosing thyroid carcinoma and each kind of exams has its ownadvantage and limitation in which ultrasound is recommended as the first choice ofimaging exam to screen the thyroid nodule. In recent years the scientific and technologicalimprovement bring a leap of the image definition and probe’s frequency elevation, andthen the image quality of superficial organs improved well. More and more nodulessmaller than5mm can be detected and we can even find nodule around1mm. Thestructure of the nodule and be showed on ultrasonography to help the doctors on diagnose.The indexes of diagnosing the nodule are nodule’s size, echogenic, boundary, calcification,echo attenuation behind the nodule, and the suspicious cervical lymph node. It is crucial todecide which one or several indexes are more relevant to the thyroid malignant carcinoma.PART1Analysis of ultrasonic characteristics of thyroid carcinomaObjective：By observing the ultrasonography performance of226Cases of thyroidnodules confirmed by surgery and pathology，carried on the single factor and themulti—factor analysis. To obtain the most relevant ultrasonography features for thediagnosis of thyroid carcinoma. To provide a theoretical basis for identifying benign andmalignant thyroid nodules easily． Methods：Selected226cases of thyroid nodules admitting to our hospital generalsurgical department from June2012to2013．All patients were preoperatively withcolorDoppler ultrasonography, careful observation and recording of two-dimensional andcolor Doppler ultrasonic performance of lesions was made，including lesion number, size，baundary，internal echo， strong-echoes，halo sound, rear attenuation, flow classification，flow resistance index, and suspicious cervical lymph node．After operation and pathologycomparison，carried on the single factor and the Logistic multi—factor regression analysis,screened the thyroid carcinoma related ultrasonic characteristics．Results：1.226nodules contain167for malignancy and59for benignity. Accuracyis83.6%and misdiagnose rate is16.3%.2. By single factor analysis, to diagnose thethyroid carcinoma, the meaningful ultrasonic characteristics includes fuzzy boundary,hypoechogenity, taller than wide, calcification rear attenuation, and suspicious lymphnodes. By logistic regression analysis, thyroid cancer associated ultrasonic characteristicsincludes fuzzy boundary, calcification, taller than wider, rear attenuation, and suspiciouslymph nodes.Conclusion1. By logistic regression analysis, thyroid cancer associated ultrasonic]characteristicsincludes fuzzy boundary, calcification, taller than wider, rear attenuation, and suspiciouslymph nodes.2. Ultrasound is quite useful in diagnosing the thyroid nodule and can provideconfident guide to deal with the nodules. PART2Application value of calcification in the diagnosis ofthyroid nodules in ultrasoundObjective: Our study aimed to analyze the relationship between calcification typesand thyroid nodules, and to explore the value of calcification in the diagnosis of thyroidnodules in ultrasound.Methods:226thyroid nodules in201patients with thyroid resection in our hospitalfrom March2012to December2013were analyzed retrospectively. All patients underwent color doppler ultrasonography examination pre-operatively. The evaluation was foucsed onthe the size, shape and distribution of calcification inside thyroid nodules. Differentcalcification patterns were divided into3types: type1micro-calcification, type2coarsecalcification, type3peripheral calcification. This study analyzed the difference ofcalcification rate between malignant and benign nodules and compared the difference ofcalcification ratio in benign and malignant thyroid with Chi-square test in threecalcification patterns respectively.Result: Postoperative pathologic results of226thyroid nodules included20cases ofthyroid nodular goiter,39cases of thyroid adenoma,167cases of carcinoma. Thecalcification rate of all nodules was50.44%(114/226). While the calcification rate ofmalignant nodules59.88%(100/167) was significantly higher than that of benign nodules23.72%（14/59）(χ2=35.216，P＜0.01). The ratio of type1calcification in malignantnodules52.69%(88/167) was obviously higher than that of benign nodules5%(3/59)(χ2=39.523, P＜0.01). There was no significant difference of type2calcification betweenmalignant and benign nodules [4.79%（8/167）vs5.08%(3/59), χ2=7.216，P＞0.05]. Theincidence of type3calcification in malignant lesions4.19%(7/167) was lower than that ofbenign nodules8.47%(5/59), but no significant difference was found between them(χ2=11.581, P＞0.05).Conclusion: Calcification was more prone to occur in malignant thyroid nodules thanbenign nodules, and there was potential risk of malignancy in each calcification of thyroidnodules. Different calcification types had important value for differential diagnosis ofbenign and malignant nodules.