超声对滤泡型甲状腺乳头状癌和滤泡性腺瘤的鉴别诊断价值

Value of ultrasonography in the differential diagnosis of follicular variant of papillary thyroid carcinoma and follicular adenoma

目的探讨超声在滤泡型甲状腺乳头状癌(FVPTC)和滤泡性腺瘤(FA)鉴别诊断中的应用价值。方法回顾性分析经手术病理证实的42例FVPTC和57例FA的超声声像图特征,结合病理对照研究。结果依据病灶有无包膜,FVPTC分为包膜内型和非包膜内型。非包膜内型FVPTC结节平均大小显著小于FA结节(17.42±11.34 vs 30.14±13.21,P<0.05)。包膜内型FVPTC与FA结节形态、声晕、实性成分回声均匀性等声像图特征差异有统计学意义。非包膜内型FVPTC与FA结节形态、边界、纵横比、声晕、回声、实性成分均匀性、钙化、血流分布特征差异均有统计学意义。27例包膜内型FVPTC超声特征表现为"可能良性"12例和"可疑恶性"15例,15例非包膜内型FVPTC超声特征均表现为"可疑恶性"。结论不同病理类型FVPTC超声表现差异较大,结合形态、声晕、实性成分回声均匀性等特征将有助于FA的鉴别诊断。

Objective To evaluate the usefulness of ultrasonography in distinguishing follicular variant of papillary thyroid carcinoma （FVPTC）from follicular adenoma （FA）.Methods With corresponding pathological features taken into account,sonographic features of 42 patients with FVPTC and 57 patients with follicular adenoma confirmed by surgery and pathology were retrospectively analyzed.Results Ac-cording to the lesion with or without capsular,the FVPTC was categorized into encapsulated and nonencapsulated types.Mean tumor diameter was markedly lower in nonencapsulated FVPTC compared to FA （17.42 ±11.34 vs 30.14 ±13.21 mm,P 〈0.05）.Sonographic features of shape,sonographic halo,and echotexture were statistically significant between encapsulated FVPTC and FA.Sonographic features of shape, margin,aspect ratio,sonographic halo,echogenicity,echotexture,calciications,and color flow were all statistically significant between nonen-capsulated FVPTC and FA.Of the 27 nodules diagnosed as encapsulated FVPTC,12 showed “probably benign”US features and 15 showed“suspicious malignant”US features,while 15 nodules diagnosed as nonencapsulated FVPTC all showed “suspicious malignant”US features. Conclusions Different pathological subtypes of FVPTC have different sonographic appearances.Combining with US features such as shape, sonographic halo,and echotexture,it will be useful in the differential diagnosis of these lesions and FA.