甲状腺微小乳头状癌常见超声表现的病理学基础

Common characteristic of papillary microcarcinoma of thyroid in ultrasound and pathology

目的探讨甲状腺微小乳头状癌常见超声表现的病理学基础。方法选取2012年1—6月在上海交通大学医学院附属瑞金医院行手术治疗并经病理确诊的甲状腺微小乳头状癌患者共117例,每例患者仅评估1个经病理证实的甲状腺结节,总共评估117个结节。分析超声下结节的形态与边界、内部回声、声晕、后方回声及钙化,镜下肿瘤的浸润程度、内部构成以及钙盐沉积。结果 117个甲状腺微小乳头状癌超声下主要表现为形态不规则(87.18%,102/117)、边界不清(80.34%,94/117)、内部低回声(90.60%,106/117)以及微钙化(65.81%,77/117),而镜下主要表现为浸润性生长(93.16%,109/117)、内部以细胞成分为主(46.15%,54/117)以及钙化灶(56.41%,66/117)。镜下呈浸润式生长的109个肿瘤中,102个(93.58%)结节超声表现为形态不规则,91个(77.78%)结节超声表现为边界不清晰。而8个镜下非浸润式生长的肿瘤均为超声表现为形态规则的结节。13个超声下出现声晕的结节中,8个镜下发现了肿块周围有明显的纤维包膜包绕。无论镜下肿瘤内部构成如何,超声下均以低回声结节为主。超声下高回声结节镜下均以细胞成分为主。镜下发现钙化的肿瘤中53.03%(35/66)超声同样探及钙化,46.97%(31/66)超声未探及钙化。镜下未发现钙化灶的肿瘤中82.35%(42/51)超声探及钙化,17.65%(9/51)超声未探及钙化。结论甲状腺微小乳头状癌的超声表现均有其一定的病理学基础,正确认识两者之间的关系将有助于提高超声医师诊断甲状腺结节的准确率。

Objective To explore the pathological basic of some common characteristic of papillary microcarcinoma of thyroid in ultrasound. Methods Totally 117 thyroid papillary microcarcinomas that were completed all thyroid ultrasound examinations before the surgical excisions were collected. Shape, border, internal echogenicity, halo, posterior echogenicity and calciifcation were observed in ultrasound. While the degree of inifltration of the tumor, the tumor’s internal structure as well as calciifcation was observed in pathology. Results IIrregular shape （87.18%, 102/117）, unclear border （80.34%, 94/117）, hypoechoic （90.60%, 106/117） and microcalciifcations （65.81%, 77/117） were recognized by ultrasound while the main pathological features were invasive growth （93.16%, 109/117）, cell components internally （46.15%, 54/117） and calciifcation （56.41%, 66/117）. Of the 109 neoplasms which were invasive growth in pathology, 102 （93.58%） nodules presented irregular shape in ultrasound while 91 （77.78%） presented unclear border. All of the 8 neoplasms which were not invasive growth in pathology showed regular shape in ultrasound. Thirteen nodules showed halos in ultrasound, and 8 of them showed visible ifbrous capsule surrounding the mass. Whatever the tumor’s internal structure was, most nodules presented hypoechoic. And the hyperechoic nodules were all found cell components internally. Of the 66 neoplasms which were found calciifcation by microscope, 35 （53.03%） nodules showed calciifcation in ultrasound and 31 （46.97%） did not. And of the 51 neoplasms in which calciifcation were not found by microscope, 42 （82.35%）＆amp;nbsp;nodules showed calciifcation in ultrasound and 9 （17.65%%） did not. Conclusions There is no doubt that all the performances of papillary microcarcinoma in ultrasound have bases in pathology. It is helpful to the judgment of a thyroid nodule if we could understand the correlation of performances in ultrasound and pathology.