甲状腺滤泡癌的超声声像图特征

Sonographic features of follicular thyroid carcinoma

目的探讨甲状腺滤泡癌的超声声像图特征。方法回顾性分析经手术病理证实的36例甲状腺滤泡癌患者(微浸润型滤泡癌31例,广泛浸润型滤泡癌5例)及52例甲状腺滤泡性腺瘤患者的临床及超声声像图资料,供分析的超声声像图参数包括:肿瘤大小(最大直径)、声晕、囊性成分比例、实性成分回声类型及均匀性、钙化情况和结节个数,临床参数包括患者的年龄和性别。采用t检验(患者年龄、肿瘤最大直径)或χ2检验(囊性成分比例、声晕、实性成分回声类型及均匀性、钙化情况、结节个数和患者的性别)分析各参数在甲状腺滤泡癌和甲状腺滤泡性腺瘤间的差别。结果甲状腺滤泡癌以实性为主(100.0%,36/36),多呈低回声(69.4%,25/36),实性成分回声多不均匀,呈斑片状等回声及低回声相间改变(83.9%,26/32),超过一半的滤泡癌内部及周边可见钙化灶(55.6%,20/36),周围多表现为无明显声晕或声晕薄厚不均(69.4%,25/36);而甲状腺滤泡性腺瘤则以囊实混合性或囊性为主(61.5%,32/52),实性成分多呈等回声(63.5%,33/52),内部回声多较均匀(80.8%,42/52),伴钙化少见(7.7%,4/52),声晕存在且多薄而均匀(86.5%,45/52)。以上特征甲状腺滤泡癌与甲状腺滤泡性腺瘤比较,差异均有统计学意义(χ2=34.813、28.596、35.256、25.052、28.811,P均<0.01)。甲状腺滤泡癌与甲状腺滤泡性腺瘤患者平均年龄、肿瘤最大直径比较,差异均无统计学意义(t=0.222、-1.228,P=0.825、0.223)。甲状腺滤泡癌患者中肿瘤最大直径>40 mm所占比例为22.2%(8/36)、单个结节的比例为31.3%(12/24)、男性比例为25.0%(9/27)、年龄>45岁者的比例为66.7%(24/36),与甲状腺滤泡性腺瘤的17.3%(9/52)、21.2%(11/41)、23.1%(12/40)和71.2%(37/52)相比,差异均无统计学意义(χ2=0.330、1.635、0.043、0.201,P均>0.05)。结论甲状腺滤泡癌患者的超声声像图特征为肿瘤偏实性、回声较低、回声欠均匀、存在钙化以及声晕厚薄不均。

Objective To determine sonographic features of thyroid follicular carcinoma ( FC) in comparison with thyroid follicular adenoma ( FA ).Methods This retrospective study included 36 pathologically proven FCs (5 widely invasive FCs and 31 minimally invasive FCs)and 52 FAs in 88 patients who underwent thyroid surgery .We analyzed clinical features of each patient ,including patient gender,age, and sonographic features of each tumor , including maximum diameter, peripheral halo, echogenicity, echotexture,calcifications and nodule number .These clinical and sonographic findings were compared by using t test ( age and diameter ) or the χ2 test (sex ratio,halo,echogenicity,echotexture,calcifications and nodularity)between FAs and FCs.Results For sonographic features,predominantly solid content(100.0%, 36/36),hypoechoic echogenicity (69.4%,25/36),inhomogeneous echotexture (83.9%,26/32),presence of calcifications(55.6%, 20/36) and without or with irregular halo (69.4%,25/36) were more commonly found in FCs.In comparison,FAs were more likely to present with mixed or predominantly cystic content (61.5%,32/52),isoechoic echogenicity (63.5%,33/52),homogeneous echotexture (80.8%,42/52), absence of calcifications (7.7%,4/52) and thin halo (86.5%,45/52) ( χ2 =34.813,28.596,35.256, 25.052,28.811,all P<0.01).The maximum diameter and mean age did not show statistically significant&nbsp;difference between FCs and FAs (t=0.222,-1.228,P=0.825,0.223).The proportions of tumor larger than 40 mm(22.2%,8/36 vs 17.3%,9/52),solitary nodule(31.3%,12/24 vs 21.2%,11/41),male sex (25.0%,9/27 vs 23.1%,12/40)and patient older than 45 years(66.7%,24/36 vs 71.2%,37/52)did not show statistically significant difference between FCs and FAs ( χ2 =0.330,1.635,0.043,0.201,all P>0.05).Conclusion Sonographic features,including predominantly solid content ,hypoechoic echogenicity, inhomogeneous echotexture ,presence of calcifications and without or with irregular halo were more commonly seen in FCs.