超声影像学特点对甲状腺髓样癌的诊断价值

Predictive value of sonographic features in preoperative evaluation of medullary thyroid carcinoma Bao

目的总结甲状腺髓样癌超声影像学特点，探讨超声对甲状腺髓样癌的诊断价值。方法回顾性分析1993年1月至2013年1月在解放军总医院手术并经术后病理证实的甲状腺髓样癌患者临床资料，根据结节性质、术前是否穿刺活检以及术后病理有无淋巴结转移进行分组，比较两组间超声影像学特点。结果（1）20年间共收治86例患者（92个髓样癌结节），男女之比为1：1．3，平均年龄（47±12）岁；（2）78．3％（72／92）癌结节有完整超声资料，平均直径为（2．1±1．3）cm；甲状腺髓样癌主要超声影像学特征为实性、低回声、边界清晰、形态规则及纵横比（A／T）〈1，部分伴有钙化（微小钙化多见）及易伴发颈部淋巴结异常肿大；（3）与自身良性结节比较，恶性结节钙化率更高（48．6％比5．6％，P=0．001），形态不规整（30．6％比5．6％，P=0．030），内部有血流者更多见（57．0％比22．2％，P=0．030）；（4）根据结节术前是否进行穿刺活检，伴颈部淋巴结肿大者接受穿刺活检更多（76．0％比55．3％，P=0．084）；（5）与不伴颈部淋巴结转移者比较，伴颈部淋巴结转移的癌结节边缘不清晰（36．4％比12．8％，P=0．009）更多见。超声显示颈部淋巴结异常肿大有提示意义（96．2％比51．7％，P=0．000）。结论甲状腺髓样癌除具有恶性结节常见的超声影像学特点如实性、低回声及伴有微钙化之外，还有其独特的影像学特征即形态规整、边界清晰、A／T〈1和易伴发颈部淋巴结异常肿大。

Objective To summarize ultrasound features associated with medullary thyroid carcinonm （MTC） and investigate the predictive value of uhrasonography in preoperative diagnosis of MTC. Methods The sonographic and clinical data were studied in a series of nodules histologically proven as MTC collected from January 1993 to January 2013. Results A total of 86 patients （92 nodules proven as MTC） were enrolled in the study with an average age of （47 ± 12） years. Among the MTCs, 21.7% （20/ 92） were excluded because of missing data and the remained 78.3% （72/92） had complete data with the average diameter of （ 2. 1 ± 1.3 ） cm. The common US findings for MTC were solid, hypoechogenicity, regular sharp, well-defined margin, AP/ TR 〈 1 and calcification （ mostly microcalcification）. Calcification and vascularization were more common in MTC nodules （ 48.6% vs 5.6% , P = 0. 001 ） . Nodules with enlargement of cervical lymph node tended to be undergone FNAB（76.0% vs 55.3% ,P =0. 084） , and illdefined margin was more common in MTC nodules with cervical lymph node metastasis（36.4% vs 12. 8% , P = 0. 009）. Conclusion Despite having a few US features closely linked to the malignant nodules such as solid, hypoechogenicity and with microcalcification, the MTC nodules also have specific US imaging characteristics as regular sharp, well-defined margin and AP/TR 〈 1.