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px215467 · Wysłany: Śro 1:28, 23 Mar 2011 Temat postu: MBTシューズ &#36

Multiple thyroid nodules with thyroid carcinoma

Slow growth of thyroid general, longer course, early clinical symptoms and signs are not typical, it is only by the collection and examination history is not enough. Need some of the clinical examinations. Imaging 2.1 include: ① B super, especially for high-resolution color Doppler ultrasound: the number of thyroid nodules, size, and the diagnosis of cystic-solid high degree of accuracy, it is reported can be detected in the actual diameter of 3mm of Results Festival 【3J, but the diagnosis of thyroid nodules is a lack of specificity. ② thyroid scintigraphy: a display function and morphology of thyroid nodule characteristics, we can understand the size of nodules, number and function, because of cold nodules of thyroid scan in thyroid cancer incidence is not high, their thyroid nodule The detection rate and to distinguish benign and malignant can not provide a reliable basis, especially in some small nodular goiter positive rate of cancer patients lower ③ X ray: calcification of the neck X ray film for nodular goiter degeneration or thyroid cancer,[link widoczny dla zalogowanych], if any, change prompt invasive tracheal malignant nodules, but the proportion of such cases accounted for less clinical. ④ CT: large and fixed in the mass, CT in the diagnosis and treatment help, it can determine the cervical lymph node metastasis of thyroid cancer in and around the organs affected by violations to help the clinical treatment plan and prognosis, but its small cancer detection rate is not high, no specificity, so the clinical application of less. Taking these factors alone imaging to diagnose thyroid cancer is not enough. 2.2 The pathological diagnosis including fine needle aspiration biopsy and intraoperative frozen biopsy rapid pathology. Identification of benign and malignant nodules they are the most effective method. Multiple thyroid nodules, but more commonly as a single cancerous nodule, fine needle aspiration, the positive rate is not high, and without suspected cancer, multiple nodules all patients before the line can not be the routine examination. National data show that the correct rate varied widely,[link widoczny dla zalogowanych], with the piercing and the pathologist's experience who have a direct relationship, even if the fine needle aspiration biopsy is still not completely negative except for the possibility of malignancy. Fine needle aspiration biopsy for the damage due to checking, checking are also likely to have some complications, so we check the method of fine needle aspiration biopsy still have objections. The rapid intraoperative frozen section pathological examination will not impact on the patient, the method is simple, drawing a wide area, it should be significantly higher than the accuracy of fine needle aspiration biopsy. As long as drawn reasonable film-reading accuracy, rate of diagnosis more than 90%, and thus thyroid benign and malignant tumors of the identification and selection of operative methods have a significant role. From this group of 27 cases of thyroid cancer are differentiated thyroid cancer of view, the course up to 20 years, some for the thyroid cancer, preoperative clinical examination, imaging studies and fine needle aspiration biopsy diagnosis of only 9 cases, more than 18 patients before surgery had no typical clinical presentation, not suspicious clinically palpable nodules, and by imaging studies found no suspicious tumor, fine needle aspiration examination also were not clearly malignant. Some have even been diagnosed as benign nodular goiter and other diseases, so without further examination, are important causes were misdiagnosed the reason. On our hospital due to a thyroid surgery each patient underwent rapid intraoperative frozen section pathological examination,[link widoczny dla zalogowanych], it is obtained in the surgery more precise diagnosis. The 18 cases of thyroid cancer are surgery rapid pathological diagnosis, and no one missed surgery, including two cases of intraoperative rapid pathological as suspicious malignant, surgery gland directly Unilateral isthmus resection and removal from the surface to avoid the re- operation and protect the last minute of diagnosis. Combination of experience and related literature, we believe that intraoperative frozen should be noted as follows: intraoperative findings incision into quality hard white lumps or fish-like, and the surrounding tissue adhesion and surrounding lymph nodes,[link widoczny dla zalogowanych], and they should pay particular attention to detail with the pathologist ; on preoperative or intraoperative diagnosis of newly discovered suspicious nodules should be sent to each of the frozen, because some small cancer nodules, especially in appearance and difficult to distinguish benign nodules; surgery when nodules were found the coexistence of nodules of other extra vigilance; derived tissues should be avoided while taking a hard liquefied solid organization,[link widoczny dla zalogowanych], and drawn and should be broad; suspected cases of frozen as far as possible on the side of the isthmus of thyroid removed all therefore legitimate, once pathologically confirmed thyroid cancer, but also try to avoid another surgery. 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