| ObjectiveThis thesis aims to collect thyroid nodules in patients with postoperative pathological results, as well as the corresponding age, gender, functional examination, ultrasound, summarize postoperative pathological classification of thyroid nodule,and analyze the correlation between the above-metioned factors and pathological types of thyroid nodule. It is helpful for clinicians to discriminate benign thyroid nodules from malignant ones.Materials and Methods ObjectRetrospective analysis has been made with a total of 600 patients that were comf irmed with thyroid nodules from January 2013 to June 2014, during the surgical path ology in the second affiliated hospital of nanchang university.MethodThe author collects information about patients’ age and gender, tested thyroid function including free thyroid hormone T3(FT3) and free T4(FT4)thyroid hormone,thyroid stimulating hormone(TSH), thytoid peroxidase antibody(TPOAb), resistance anti thyroglobulin antibody, explore thyroid and neck lymph nodes with two-dimensional ultrasound on both sides, observe quantity,calcified nodule, the internal structure, the echo types, neck lymph nodes sonograms and postoperatively pathological paraffin cover, wood red- eosin staining, the experienced pathologist diagnostic analysis. The results of paraffin pathology provides reference for the final diagnosis, those patients were divided into either benign group or malignant group.Result(1)516 cases of the 600 patients with thyroid nodules were found with benign nodules, and 420 cases were with nodular goiter,47 cases with thyroid adenoma, and43 cases with chronic lymphocytic thyroiditis, 4 cases with granulomatous thyroidnodule, 1 case with sui thyroid tumor, 1 case with eosinophilic cell tumor. There are 84 cases with malignant nodules, including 73 cases with papillary carcinoma,follicular carcinoma in 5 cases, sui carcinoma of thyroid in 3 cases, undifferentiated thyroid carcinoma in 1 case, clear cell carcinoma in 1 case, and malignant lymphoma in 1 case. The ratio of cases with benign thyroid nodule to those with malignant one was 6.14:1; 37 out of the 516 cases with benign thyroid nodules was nodular goiter with lymphocytic thyroiditis(accounting for 6.2% of all thyroid nodules), and 7 cases was nodular goiter with adenoma goiter(accounting for 1.2% of all thyroid nodules).Among the 84 cases with malignant thyroid nodule, 16 cases with nodular goiter was with papillary carcinoma(accounting for 2.7% of all thyroid nodules), 13 cases with lymphocytic thyroiditis was with papillary carcinoma(accounting for 30.2% of the total lymphocytic thyroiditis), 1 case with nodular goiter was with follicular carcinoma(accounting for 0.2% of the total goiter), 1 case with nodular goiter was with sui carcinoma of thyroid(accounting for 0.2% of all thyroid nodules), 1case with nodular goiter was with clear cell carcinoma(accounting for 0.2% of all thyroid nodules).(2) Among the 600 patients, 89 male and female in 511 cases, the ratio of male to female was 1: 5.74. The proportion of women patients were significantly higher than male ones. Among the 600 cases, 516 cases were found with benign nodule,accounting for 86% of the total, 84 cases with malignant nodule, accounting for 14%.The proportion of benign nodules were significantly higher than that of malignant nodules. Among the 89 malignant patients, the number of male patients was 25,accounting for 28.09% of the total, the percentage of female cases was 11.55%(59/511). Clearly, malignant male patients were more than female patients. The difference was statistically significant(X2 = 17.23, p < 0.05).(3) The average age of patients with benign nodules is 49.45±12.71 years, and that of the patients with malignant nodules is 41.62 ±11.24. Patients with malignant nodules are younger than those with benign nodules(P < 0.05). The difference is statistically significant. Most patients with malignant thyroid nodule are younger than 25(35.89%). The rate is reducing with the increase of age. Patients with thyroid nodule and older than 60 are less likely to be found with malignant thyroidnodule(5.22%). The difference between different groups was statistically significant(X 2= 35.78,df= 3, P < 0.05).(4) Laboratory examination: there is no statistically significant difference in preoperative serum FT3, FT4, Tg Ab, TPOAb among patients from either benign or malignant group(p > 0.05). in differentiated thyroid cancer,(TSH ≦0.350/ m IU L)The malignant rate is the lowest(6.56%),(TSH ≧ 5.500 m IU/L) that is the highest(41.94%). There was statistically significant difference between the serum TSH concentrations(X 2= 28.50,df = 3, p < 0.05).(5) All of the 600 Patients have received ultrasound examination about thyroid nodule. The results indicate that statistically significant differences exist in internal microcalcification, internal structure, the echo types, the neck lymph node enlargement among benign and malignant patients.According to the Ultrasound examination, the rate of microcalcification in the benign group is 12.60%, the coarse calcification rate is 14.15%,the rate of total calcification 26.75%. In the malignant group, the microcalcification rate is 55.95%,the coarse calcification rate is 13.10%, the rate of total calcification is 69.05%. In the group of malignant nodules, 47 cases were found with microcalcification, while in the group of benign nodules, the number is 65. Significant statistical difference exists in the distribution of microcalcification between the two groups(X 2 = 19.20, P <0.01). In the group of malignant nodules, 11 cases were found with coarse calcification, while in the benign nodules group the number is 73. The difference in the distribution of coarse calcification between the two groups is no statistically significant(X 2 = 0.07).According to the results of ultrasound examination, the rate of single nodules in the malignant group was 16.67%, but that of multiple nodules was 13.29%. There was no statistically significant difference between the two groups(X 2=1.46). In this study, the proportion of malignant nodules in solid nodules is46.43%,while that of begnin nodules is 28.29%,There was significant difference between the two groups(X 2=11.14, P < 0.01). In this study the proportion of malignant nodules low echo tubercle is 42.86%; and that of benign nodules was11.05%. There was significant difference between the two groups(X 2= 55.81, P <0.01). In this study, the rate of neck lymph node enlargement among malignantnodules is 53.57%, and that among benign nodules is 12.21%. There was significant difference between the two groups(X 2= 83.73, P < 0.01).(6) Among 84 cases of malignant thyroid nodule, 16 were found with papillary carcinoma(accounting for 2.7% of all thyroid nodules), 13 cases of lymphocytic thyroiditis with papillary carcinoma(30.2%) of all lymphocytic thyroiditis, 1 case of nodular goiter with follicular carcinoma(accounting for 0.2% of the total goiter), 1case of nodular goiter with sui carcinoma of thyroid(accounting for 0.2% of all thyroid nodules), 1 case of nodular goiter with clear cell carcinoma(accounting for0.2% of all thyroid nodules), the coexistence of benign and malignant cases accounted for 38.1% of malignant thyroid nodules.Conclusion(1)Among thyroid nodules, benign nodules are more than malignant nodules.The most common benign nodules are nodular goiter, and the most common malignant nodules are papillary carcinoma.(2)The most common thyroid nodules are found in female, but more male patients are found with malignant thyroid nodule than female ones.(3)Among patients with thyroid nodules, the younger the patients are the more likely they are found with malign nodules.(4)For thyroid nodules, the malignant rate increases with the concentration of serum TSH.(5)For thyroid ultrasound examination, microcalcification in the thyroid nodule,solid nodules, low echo, neck lymph nodes enlargement are of certain significance for the identification of benign and malignant nodules. Combining multiple thyroid ultrasound comprehensive analysis will be of help in the identification of benign and malignant nodules.The coexistence of benign and malignant nodules in the thyroid nodule is not scarce. The proportion of tiny carcinoma(30 cases) in thyroid nodules is not negligible, to which clinicians should pay enough attention. |
PDF Full Text Request