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甲状腺癌CT误诊为结节性甲状腺肿、甲状腺腺瘤的临床分析 被引量:1

Clinical Analysis of Thyroid Carcinoma Misdiagnosed by CT as Nodular Goiter and Thyroid Adenoma
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摘要 目的分析甲状腺癌CT误诊为结节性甲状腺肿、甲状腺腺瘤的原因及防范措施。方法回顾性分析2020年2月—2022年3月收治的甲状腺癌误诊病例12例的临床资料。结果12例均以颈前无痛性单发肿物(右侧5例、左侧7例)就诊,甲状腺均增大,5例可触及多个颈部增大淋巴结;出现声嘶、呼吸困难等压迫症状5例;肿物质硬,吞咽时活动性差5例。12例中形状不规则7例,边界清楚4例;3例肿物邻近气管、肌肉或血管浸润包埋,4例包膜欠完整,5例颈部淋巴结增大。12例增强扫描均表现为不均匀强化。误诊为甲状腺腺瘤7例、结节性甲状腺肿5例,均拟行手术治疗,经术中冰冻切片及术后病理检查证实为甲状腺癌,病理类型为乳头状腺癌。误诊时间2~3 d。12例中行患侧腺叶切除术8例,患侧腺叶+峡部切除术4例,同时行患侧增大颈部淋巴结清除术5例,术后予以放疗6例。12例术后均口服甲状腺素片防止复发。术后随访1年,均存活且未复发。结论甲状腺癌患者早期常无明显症状,多以无痛性颈部肿物就诊,若CT影像不典型,未及早行针刺细胞学病理检查,易导致术前误诊。提高对本病的警惕性,认真询问病史,仔细查体,熟知CT影像学征象,及早行针刺细胞学病理检查,可有效避免术前误诊。 Objective To analyze the causes and preventive measures of thyroid cancer misdiagnosed by CT as nodular goiter and thyroid adenoma.Methods The clinical data of 12 patients with thyroid cancer misdiagnosed in our hospital from February 2020 to March 2022 were retrospectively analyzed.Results All 12 patients were treated with single,painless mass in the anterior neck(5 cases on the right side and 7 cases on the left side),and all of them had enlarged thyroid gland.Multiple enlarged cervical lymph nodes were palpated in 5 patients,and pressure symptoms such as hoarseness and dyspnea were found in 5 patients.The swelling material was hard and the activity of swallowing was poor in 5 patients.Of the 12 cases,7 had irregular shape and 4 had clear boundary.In 3 cases,the tumor was infiltrated near the trachea,muscle or blood vessel,the capsule was incomplete in 4 cases,and the cervical lymph nodes were enlarged in 5 cases.All the 12 cases showed uneven enhancement by enhanced scan.The patients were misdiagnosed as thyroid adenoma in 7 cases and nodular goiter in 5 cases,all of which were to be treated by operation.They were confirmed as thyroid cancer by intraoperative frozen section and postoperative pathological examination.The pathological type was papillary adenocarcinoma.The duration of misdiagnosis was 2-3 days.Among the 12 cases,8 cases underwent adenolobectomy,4 cases underwent adenolobectomy+isthmusectomy,5 cases underwent removal of enlarged neck lymph node on the affected side,and postoperative radiotherapy was given to 6 cases.Oral thyroxine tablets were given to 12 cases to prevent recurrence.At 1-year follow-up,all patients survived without recurrence.Conclusion Patients with thyroid cancer often have no obvious symptoms in the early stage and mostly presented with painless neck masses.If the CT images are not typical and the cytological examination of acupuncture is not performed early,preoperative misdiagnosis is more likely to occur.It is necessary to improve the vigilance of the disease,carefully inquire about the history,carefully perform physical examination,be familiar with CT imaging signs,conduct early needle aspiration cytology and pathological examination,to effectively avoid preoperative misdiagnosis.
作者 张亚杰 于泽洋 项昆 王卓 ZHANG Yajie;YU Zeyang;XIANG Kun;WANG Zhuo(Department of Medical Imaging,Kailuan General Hospital,Tanshan,Hebei 063000,China;Department of Medical Imaging,the Second Hospital of Tangshan City,Tangshan,Hebei 063015,China;Department of Medical Imaging,Tangshan Union Hospital,Tangshan,Hebei 063006,China)
出处 《临床误诊误治》 CAS 2023年第12期27-31,共5页 Clinical Misdiagnosis & Mistherapy
基金 河北省卫健委重点课题计划(20201546)。
关键词 甲状腺癌 误诊 甲状腺腺瘤 结节性甲状腺肿 良恶性 体层摄影术 螺旋计算机 活组织检查 针吸 鉴别诊断 Thyroid cancer Misdiagnosis Thyroid adenoma Nodular goiter Benign and malignant Tomography,spiral computed Biopsy,needle Differential diagnosis
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