甲状腺乳头状微小癌77例临床分析

Clinical analysis of 77 cases of papillary thyroid microcarcinoma

目的 探讨甲状腺乳头状微小癌（PTMC）的临床特点.方法 2011年11月至2013年11月我科行甲状腺细针穿刺活检（FNAB）诊断为甲状腺乳头状癌（PTC）或可疑PTC且于我院手术者129例,于我院外科行手术治疗的PTMC患者77例,对此77例PTMC患者临床资料进行回顾性分析.应用SPSS 20.0软件分析相关数据.结果 129例中,经手术病理证实2例为良性,余127例均为乳头状癌,符合率98.4％;其中PTMC 77例,占60.6％.77例PTMC中,经FNAB检测BRAF基因阳性者51例,17例有颈部淋巴结转移,发生率33.3％;阴性者18例,有5例转移,发生比例为5/18（χ^2=0.189,P＞0.05）.多个病灶者31例,其中14例（45.2％）有颈部淋巴结转移;单一病灶者46例,其中9例（19.6％）有颈部淋巴结转移（χ^2=5.792,P＜0.05）.129例中,118例行BRAF基因检测,其中89例BRAF基因阳性,阳性率为75.4％;77例PTMC患者中,69例行BRAF基因检测,51例阳性,阳性率为73.9％.结论 虽然大多数PTMC生长缓慢且较隐匿,但早期淋巴结转移及多灶性是其主要临床特征,临床对PTMC不能忽视.

Objective To analyze the clinical characteristics of papillary thyroid microcarcinoma （PTMC）.Methods One hundred and twenty nine patients preoperatively diagnosed as papillary thyroid carcinoma （PTC） or suspicious PTC by fine needle aspiration biopsy （FNAB） underwent thyroidectomy,and 127 cases were confirmed as PTC histopathologically,among whom 77 cases were microcarcinoma （60.6%）.The clinical data of 77 PTMC cases were retrospectively analyzed with SPSS （20.0） statistical software.Results In 77 PTMC cases,BRAF gene detection was performed in 69 cases,51 cases showed positive BRAF （73.9%） and 18 cases were negative.Among patients with positive BRAF,17 cases had cervical lymph node metastasis （33.3%）;and in those with negative BRAF,5 cases had metastasis （5/18,χ^2 =0.189,P 〉 0.05）.In 31 patients with multiple lesions,14 had cervical lymph node metastasis （45.2%）;while in 46 patients with single lesion,9 had metastasis （19.6%） （χ^2 =5.792,P 〈 0.05）.Conclusion Although PTMC growth is slow and occult,early lymph node metastasis is not rare,particularly for patients with multiple lesions.