甲状腺未分化癌和乳头状癌超声成像特征的差异

Comparison of Ultrasonic Features between Anaplastic Thyroid Carcinoma and Papillary Thyroid Carcinoma

目的探讨甲状腺未分化癌和甲状腺乳头状癌超声成像特征的差异。方法回顾性分析2001年4月至2014年6月在北京协和医院就诊并经病理证实的7例甲状腺未分化癌的临床和超声特征,并以同时期内性别、年龄相匹配的21例经病理证实甲状腺乳头状癌患者为对照,分析两组的超声特征差异。结果甲状腺未分化癌的患者以女性为主(5/7,71.4%),平均发病年龄为(64.9±11.3)岁。分析超声特征结果显示,甲状腺未分化癌较甲状腺乳头状癌病灶大[(5.17±1.26)cm比(1.85±1.89)cm,P<0.001]、纵横比<1的比例高(100.0%比47.6%,P=0.03)、微钙化程度高(100.0%比52.4%,P=0.03)。两组在形态、边界、回声、均匀性、囊性变、血流状况、被膜受侵与否方面差异均无统计学意义(P均>0.05)。结论老年女性甲状腺内最大径大于5 cm结节如具备常见的超声恶性征象,同时又存在纵横比小于1和微钙化,应高度怀疑未分化癌。

Objective To explore the difference of the ultrasonic features between anaplastic thyroid carcinoma and papillary thyroid carcinoma. Methods The ultrasound data of 7 patients with histopathologically confirmed anaplastic thyroid carcinomas who were treated in PUMC Hospital from April 2001 to June 2014 were retrospectively studied. In addition,21 sex-and age-matched patients with histopathologically confirmed papillary thyroid carcinomas during the same period were enrolled as the control group. The pathologic results were regarded as the gold standard. The ultrasonic features of anaplastic thyroid carcinoma and papillary thyroid carcinomawere analyzed and compared. Results Patients with anaplastic thyroid carcinoma were predominantly females（ 5 /7,71. 4%）,with an average age of（ 64. 9 ± 11. 3） years. Large mass [（ 5. 17 ± 1. 26） cm vs.（ 1. 85 ±1. 89） cm,P 0. 001 ],anteroposterior-to-transverse diameter ratio less than 1（ 100. 0% vs. 47. 6%,P =0. 03）,and punctuate calcification（ 100. 0% vs. 52. 4%,P = 0. 03） were more frequently associated with anaplastic thyroid carcinoma than with papillary thyroid carcinoma. No significant difference was observed between the two groups in the shape, margin, cystic change, echogenicity, echotexture, vascularity, and envelope（ all P 0. 05）. Conclusion In elderly women with common malignant features on ultrasound,the thyroid nodules with a maximum diameter greater than 5 cm, anteroposterior-to-transverse diameter ratio less than 1,and microcalcifications are highly likely to be anaplastic thyroid carcinoma.