甲状腺微小乳头状癌143例肿瘤大小与超声图像特点关联研究
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摘要
目的随着超声检查技术的提升,甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)的检出率不断提高。本研究对比分析≤5mm与>5mm PTMC的超声图像特点,探讨≤5mm与>5mm PTMC的超声图像特点的差异,从而指导临床医生针对不同大小PTMC制定不同的超声诊断依据。方法收集2015-01-01-2017-12-31于大连医科大学附属大连市中心医院就诊行甲状腺癌根治术,且术前均行甲状腺超声检查、术后病理确诊为PTMC的患者143例,其中术前行超声引导下细针穿刺细胞学检查患者32例,阳性26例。将全部143例患者根据病灶最大径,分为小病灶组(直径≤5mm)及大病灶组(直径>5mm且≤10mm)2组,其中小病灶组72例,大病灶组71例。对2组患者的基本情况如年龄、性别、多发病灶例数、病灶位置进行分析,对甲状腺背景是否合并桥本氏甲状腺炎进行鉴别,对2组患者的甲状腺超声表现进行记录、总结,包括病灶回声、边界、形态、微钙化、后方回声情况、血流情况、纵横比情况及有无淋巴结转移,分析上述表现在2组中的差异。并利用Logistic回归分析筛选出区别两种大小PTMC有关联的参数。结果 2组患者基本资料对比差异无统计学意义。2组病灶的超声图像特点中,在微钙化比例(47.2%vs 71.8%,χ~2=8.980,P=0.003)、后方回声衰减比例(11.1%vs 26.8%,χ~2=5.716,P=0.017)、纵横比≥1的比例(45.8%vs 29.6%,χ~2=4.019,P=0.045)及有淋巴结转移比例(20.8%vs 43.7%,χ~2=8.538,P=0.003)方面差异均有统计学意义;而在其他方面,包括低回声比例(90.3%vs 85.9%,χ~2=1.805,P=0.406)、边界不清比例(66.7%vs 70.4%,χ~2=0.234,P=0.629)、形态不规则比例(80.6%vs 76.1%,χ~2=0.426,P=0.514)及有血流比例(41.7%vs 56.3%,χ~2=3.079,P=0.079)差异均无统计学意义。Logistic回归分析结果显示,微钙化、淋巴结转移与PTMC>5mm有较高关联度,其OR分别为2.418(95%CI为1.107～5.278)和3.422(95%CI为1.554～7.538),均P<0.05。结论≤5mm与>5mm PTMC的超声图像特点具有一定的共性,也具有一定的差异性;两者在回声、边界、形态及血流情况方面的超声图像特点差异无统计学意义;相比于>5mm的PTMC,≤5mm的PTMC超声图像特征出现纵横比≥1的比例高,而出现钙化、后方回声衰减及淋巴结转移的比例低。
OBJECTIVE With the improvement of sonographic technology,the detection rate of papillary thyroid microcarcinoma(PTMC)continues to increase.However,the rate of missed diagnosis becomes higher as the lesion becomes smaller,especially for PTMC of less than or equal to five millimeters.We aim to compare sonographic features between thyroid papillary microcarcinomas of less than or equal to five millimeters and explore the difference between them,thereby to guide clinicians to make different ultrasound diagnostic basis for different sizes of PTMC.METHODS A total of 143 patients,from January 1,2015 to December 31,2017,that have received radical thyroidectomy with pathological diagnosis of PTMC postoperatively,and undergone ultrasonic examination preoperatively in Dalian Municipal Central Hospital were selected for research.Among them,32 patients underwent ultrasound-guided fine needle aspiration cytology before operation and the result of 26 patients were positive.The patients were classified into small PTMC group(≤5 mm,n=72)or large PTMC group(>5 mm,n=71)according to the maximum diameter of the lesion.The general characteristics of the two groups of patients,such as age,sex,number of multiple lesions,location of lesions,thyroid diseases background and combined Hashimoto's thyroiditis were summarized.The sonographic features of the lesions in the two groups were recorded and summarized,including echogenicity,boundary,morphology,microcalcification,posterior echo,blood supply,aspect transverse ratio(A/T)and lymph node metastasis.We investigated the differences of above findings between the two groups.Logistic regression analysis was used to screen out the parameters with high correlation in differentiating the two sizes of PTMC.RESULTS There was no significant difference between the two groups in the comparison of general characteristics.The sonographic features comparision of lesions in the two groups are as below:hypoechogenicity(90.3%vs 85.9%,χ~2=1.805,P=0.406),unclear boundary(66.7%vs 70.4%,χ~2=0.234,P=0.629),irregular shape(80.6%vs 76.1%,χ~2=0.426,P=0.514),blood flow(41.7% vs 56.3%,χ~2=3.079,P=0.079);microcalcification(47.2%vs 71.8%,χ~2=8.980,P=0.003),posterior echo attenuation(11.1% vs 26.8%,χ~2=5.716,P=0.017),A/T ratio greater than 1(45.8% vs 29.6%,χ~2=4.019,P=0.045),lymph node metastasis(20.8% vs43.7%,χ~2=8.538,P=0.003).Logistic regression analysis showed that microcalcification and lymph node metastasis had relatively high correlation with PTMC>5 mm.Logistic regression analysis showed that there were high correlations between microcalcification,lymph node metastasis and PTMC>5 mm,with OR of 2.418(95%CI:1.107-5.278)and 3.422(95%CI:1.554-7.538)respectively,and their corresponding Pvalues were less than 0.05.CONCLUSIONS Sonographic features of less than or equal to five millimeters and more than five millimeters PTMC have some similarities and differences;there is no difference in echogenicity,boundary,morphology and blood flow;compared with larger than 5 mm PTMC,less than or equal to 5 mm PTMC shows higher proportion of A/T>1,while microcalcification,posterior echo attenuation and lymph node metastasis was less observed.
OBJECTIVE With the improvement of sonographic technology,the detection rate of papillary thyroid microcarcinoma(PTMC)continues to increase.However,the rate of missed diagnosis becomes higher as the lesion becomes smaller,especially for PTMC of less than or equal to five millimeters.We aim to compare sonographic features between thyroid papillary microcarcinomas of less than or equal to five millimeters and explore the difference between them,thereby to guide clinicians to make different ultrasound diagnostic basis for different sizes of PTMC.METHODS A total of 143 patients,from January 1,2015 to December 31,2017,that have received radical thyroidectomy with pathological diagnosis of PTMC postoperatively,and undergone ultrasonic examination preoperatively in Dalian Municipal Central Hospital were selected for research.Among them,32 patients underwent ultrasound-guided fine needle aspiration cytology before operation and the result of 26 patients were positive.The patients were classified into small PTMC group(≤5 mm,n=72)or large PTMC group(>5 mm,n=71)according to the maximum diameter of the lesion.The general characteristics of the two groups of patients,such as age,sex,number of multiple lesions,location of lesions,thyroid diseases background and combined Hashimoto's thyroiditis were summarized.The sonographic features of the lesions in the two groups were recorded and summarized,including echogenicity,boundary,morphology,microcalcification,posterior echo,blood supply,aspect transverse ratio(A/T)and lymph node metastasis.We investigated the differences of above findings between the two groups.Logistic regression analysis was used to screen out the parameters with high correlation in differentiating the two sizes of PTMC.RESULTS There was no significant difference between the two groups in the comparison of general characteristics.The sonographic features comparision of lesions in the two groups are as below:hypoechogenicity(90.3%vs 85.9%,χ~2=1.805,P=0.406),unclear boundary(66.7%vs 70.4%,χ~2=0.234,P=0.629),irregular shape(80.6%vs 76.1%,χ~2=0.426,P=0.514),blood flow(41.7% vs 56.3%,χ~2=3.079,P=0.079);microcalcification(47.2%vs 71.8%,χ~2=8.980,P=0.003),posterior echo attenuation(11.1% vs 26.8%,χ~2=5.716,P=0.017),A/T ratio greater than 1(45.8% vs 29.6%,χ~2=4.019,P=0.045),lymph node metastasis(20.8% vs43.7%,χ~2=8.538,P=0.003).Logistic regression analysis showed that microcalcification and lymph node metastasis had relatively high correlation with PTMC>5 mm.Logistic regression analysis showed that there were high correlations between microcalcification,lymph node metastasis and PTMC>5 mm,with OR of 2.418(95%CI:1.107-5.278)and 3.422(95%CI:1.554-7.538)respectively,and their corresponding Pvalues were less than 0.05.CONCLUSIONS Sonographic features of less than or equal to five millimeters and more than five millimeters PTMC have some similarities and differences;there is no difference in echogenicity,boundary,morphology and blood flow;compared with larger than 5 mm PTMC,less than or equal to 5 mm PTMC shows higher proportion of A/T>1,while microcalcification,posterior echo attenuation and lymph node metastasis was less observed.
引文
[1]Qian K,Guo K,Zheng X,et al.Contrastive study of two screening criteria for active surveillance in patients with low-risk papillary thyroid microcarcinoma:a retrospective analysis of1001patients[J].Oncotarget,2017,8(39):65836-65848.
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[4]Yang Y,Xia S,Ni X,et al.MiR-324-5p assists ultrasonography in predicting lymph node metastasis of unifocal papillary thyroid microcarcinoma without extracapsular spread[J].Oncotarget,2017,8(48):83802-83816.
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[8]Zhao C,Jiang W,Gao Y,et al.Risk factors for lymph node metastasis(LNM)in patients with papillary thyroid microcarcinoma(PTMC):role of preoperative ultrasound[J].J Int Med Res,2017,45(3):1221-1230.
[9]张静,杨昕,王薇.甲状腺微小乳头状癌中央区淋巴结转移危险因素分析[J].山西医科大学学报,2017,48(6):593-596.
[10]Kim S,Kim K,Sung HK,et al.Clinical significance of tumor size in papillary thyroid microcarcinoma:A Meta-analysis[J].JEndocr Surg,2018,18(2):142-154.
[11]Harach HR,Franssila KO,Wasenius VM.Occult papillary carcinoma of the thyroid.A“normal”finding in Finland.A systematic autopsy study[J].Cancer,1985,56(3):531-538.
[12]Wada N,Duh QY,Sugino K,et al.Lymph node metastasis from 259papillary thyroid microcarcinomas:frequency,pattern of occurrence and recurrence,and optimal strategy for neck dissection[J].Ann Surg,2003,237(3):399-407.
[13]Shin JH.Ultrasonographic imaging of papillary thyroid carcinoma variants[J].Ultrasonography,2017,36(2):103-110.
[14]李涛.甲状腺肿块彩色多普勒超声与病理诊断结果的临床对比分析[J].中华肿瘤防治杂志,2018,25(S1):36-37.
[15]马亚凌,陈静,张雨.甲状腺癌超声征象与病理组织学类型及临床分期的联系[J].中华肿瘤防治杂志,2016,23(S1):64-65.
[16]Liu M,Liu Z,Hou Y,et al.Ultrasonographic characteristics of medullary thyroid carcinoma:a comparison with papillary thyroid carcinoma[J].Oncotarget,2017,8(16):27520-27528.
[17]刘颖,林僖,李安华,等.甲状腺乳头状微小癌与非微小癌超声特征的对比研究[J].中国超声医学杂志,2016,32(9):769-772.
[18]王昳,应怡,张春玲.应用彩色多普勒超声诊断甲状腺微小癌的可行性研究[J].中国医疗器械信息,2018,24(20):114-115.
[19]Lai X,Zhang B,Jiang Y,et al.Sonographic and clinical features of papillary thyroid microcarcinoma less than or equal to five millimeters:a retrospective study[EB/OL].PLoS One,2016,11(2):e0148567[2018-07-10].https://doi.org/10.1371/journal.pone.0148567.
[20]Gu WJ,Yan HX,Luo YK,et al.Characterization of papillary thyroid microcarcinomas using sonographic features in malignant papillary thyroid cancer:a retrospective analysis[EB/OL].Medicine(Baltimore),2015,94(21):e841[2018-07-10].https://www.ncbi.nlm.nih.gov/pubmed/26020388.
[21]张亚丽.甲状腺结节钙化对超声诊断甲状腺癌的价值分析[J].现代医用影像学,2018,27(1):207-209.
[22]Moon WJ,Jung SL,Lee JH,et al.Benign and malignant thyroid nodules:US differentiation:multicenter retrospective study[J].Radiology,2008,247(3):762-770.
[23]张恒,孙锦平,李静怡,等.超声TI-RADS分级对乳头状甲状腺癌的诊断[J].中华保健医学杂志,2018,20(3):231-233.
[24]郭晶晶,薛恩生,俞丽云,等.不同大小及位置甲状腺微小乳头状癌纵横比与被膜侵犯的关系[J].中国医学影像技术,2018,34(6):850-854.
[25]王沫.甲状腺结节超声特征对甲状腺癌诊断准确性的影响[J].医疗装备,2017,30(18):44-45.
[26]赵霞,徐丽.彩超对甲状腺结节性病变的临床诊断分析[J].现代诊断与治疗,2017,28(23):4440-4441.
[27]Xia S,Dong Y,Kang H,et al.Ultrasonography is valuable in evaluation of papillary thyroid microcarcinoma based on 5 mm tumor size[J].J Cancer Res Ther,2018,14(9):319-323.
[2]Haugen BR.2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer:what is new and what has changed?[J].Cancer,2017,123(3):372-381.
[3]Choi SY,Cho JK,Moon JH,et al.Metastatic lymph node ratio of central neck compartment has predictive values for locoregional recurrence in papillary thyroid microcarcinoma[J].Clin Exp Otorhinolaryngol,2016,9(1):75-79.
[4]Yang Y,Xia S,Ni X,et al.MiR-324-5p assists ultrasonography in predicting lymph node metastasis of unifocal papillary thyroid microcarcinoma without extracapsular spread[J].Oncotarget,2017,8(48):83802-83816.
[5]Yu X,Song X,Sun W,et al.Independent risk factors predicting central lymph node metastasis in papillary thyroid microcarcinoma[J].Horm Metab Res,2017,49(3):201-207.
[6]Cai Y,Wang Q,Ni C,et al.A scoring system is an effective tool for predicting central lymph node metastasis in papillary thyroid microcarcinoma:a case-control study[J].World J Surg Oncol,2016,14(1):45.
[7]Luo Y,Zhao Y,Chen K,et al.Clinical analysis of cervical lymph node metastasis risk factors in patients with papillary thyroid microcarcinoma[J].J Endocrinol Invest,2019,42(2):227-236.
[8]Zhao C,Jiang W,Gao Y,et al.Risk factors for lymph node metastasis(LNM)in patients with papillary thyroid microcarcinoma(PTMC):role of preoperative ultrasound[J].J Int Med Res,2017,45(3):1221-1230.
[9]张静,杨昕,王薇.甲状腺微小乳头状癌中央区淋巴结转移危险因素分析[J].山西医科大学学报,2017,48(6):593-596.
[10]Kim S,Kim K,Sung HK,et al.Clinical significance of tumor size in papillary thyroid microcarcinoma:A Meta-analysis[J].JEndocr Surg,2018,18(2):142-154.
[11]Harach HR,Franssila KO,Wasenius VM.Occult papillary carcinoma of the thyroid.A“normal”finding in Finland.A systematic autopsy study[J].Cancer,1985,56(3):531-538.
[12]Wada N,Duh QY,Sugino K,et al.Lymph node metastasis from 259papillary thyroid microcarcinomas:frequency,pattern of occurrence and recurrence,and optimal strategy for neck dissection[J].Ann Surg,2003,237(3):399-407.
[13]Shin JH.Ultrasonographic imaging of papillary thyroid carcinoma variants[J].Ultrasonography,2017,36(2):103-110.
[14]李涛.甲状腺肿块彩色多普勒超声与病理诊断结果的临床对比分析[J].中华肿瘤防治杂志,2018,25(S1):36-37.
[15]马亚凌,陈静,张雨.甲状腺癌超声征象与病理组织学类型及临床分期的联系[J].中华肿瘤防治杂志,2016,23(S1):64-65.
[16]Liu M,Liu Z,Hou Y,et al.Ultrasonographic characteristics of medullary thyroid carcinoma:a comparison with papillary thyroid carcinoma[J].Oncotarget,2017,8(16):27520-27528.
[17]刘颖,林僖,李安华,等.甲状腺乳头状微小癌与非微小癌超声特征的对比研究[J].中国超声医学杂志,2016,32(9):769-772.
[18]王昳,应怡,张春玲.应用彩色多普勒超声诊断甲状腺微小癌的可行性研究[J].中国医疗器械信息,2018,24(20):114-115.
[19]Lai X,Zhang B,Jiang Y,et al.Sonographic and clinical features of papillary thyroid microcarcinoma less than or equal to five millimeters:a retrospective study[EB/OL].PLoS One,2016,11(2):e0148567[2018-07-10].https://doi.org/10.1371/journal.pone.0148567.
[20]Gu WJ,Yan HX,Luo YK,et al.Characterization of papillary thyroid microcarcinomas using sonographic features in malignant papillary thyroid cancer:a retrospective analysis[EB/OL].Medicine(Baltimore),2015,94(21):e841[2018-07-10].https://www.ncbi.nlm.nih.gov/pubmed/26020388.
[21]张亚丽.甲状腺结节钙化对超声诊断甲状腺癌的价值分析[J].现代医用影像学,2018,27(1):207-209.
[22]Moon WJ,Jung SL,Lee JH,et al.Benign and malignant thyroid nodules:US differentiation:multicenter retrospective study[J].Radiology,2008,247(3):762-770.
[23]张恒,孙锦平,李静怡,等.超声TI-RADS分级对乳头状甲状腺癌的诊断[J].中华保健医学杂志,2018,20(3):231-233.
[24]郭晶晶,薛恩生,俞丽云,等.不同大小及位置甲状腺微小乳头状癌纵横比与被膜侵犯的关系[J].中国医学影像技术,2018,34(6):850-854.
[25]王沫.甲状腺结节超声特征对甲状腺癌诊断准确性的影响[J].医疗装备,2017,30(18):44-45.
[26]赵霞,徐丽.彩超对甲状腺结节性病变的临床诊断分析[J].现代诊断与治疗,2017,28(23):4440-4441.
[27]Xia S,Dong Y,Kang H,et al.Ultrasonography is valuable in evaluation of papillary thyroid microcarcinoma based on 5 mm tumor size[J].J Cancer Res Ther,2018,14(9):319-323.