合并桥本甲状腺炎的甲状腺乳头状癌临床病理及超声特征

Clinicopathological and Ultrasonographic Characteristics of Papillary Thyroid Carcinoma Combined with Hashimoto's Thyroiditis

目的桥本甲状腺炎(HT)及甲状腺乳头状癌(PTC)的发病率逐年升高,本研究探讨合并HT的PTC临床病理及超声图像特征,为从HT中筛查出甲状腺恶性结节及选择治疗方案提供参考。资料与方法从298例行甲状腺癌手术的患者中筛选出48例合并HT者作为研究组,同时选取70例单纯PTC患者作为对照组。比较两组PTC的临床病理特征及超声图像特征。结果 (1)与单纯PTC相比,合并HT的PTC女性及微小癌比例更高,两组年龄、肿瘤大小、多发灶及淋巴结转移率差异无统计学意义(P>0.05)。(2)两组PTC的结构、内部回声、形态、边缘、钙化、晕圈等超声特征差异无统计学意义(P>0.05)。(3)合并HT的PTC内部多无血流,单纯PTC内部多有血流。内部无血流多见于肿瘤直径≤10 mm的PTC,内部有血流多见于肿瘤直径>10 mm的PTC。结论合并HT的PTC以女性更多见,多为微小癌;具有PTC典型的灰阶超声特征;彩色多普勒超声多显示内部无血流,PTC的内部血流不仅与PTC的大小有关,可能还与是否合并HT有关。

Purpose The incidence of Hashimoto's thyroiditis(HT)and papillary thyroid carcinoma(PTC)is increasing year by year.This study aims to discuss the clinicopathological and ultrasonographic characteristics of PTC combined with HT,thus providing reference for screening malignant nodules from HT and selecting treatment plans.Materials and Methods Forty-eight PTC patients complicated with HT were screened out from 298 patients who had received thyroid carcinoma surgery(study group)and another 70 patients with simple PTC were enrolled in control group.The clinicopathological characteristics and ultrasonographic characteristics of PTC in both groups were respectively analyzed and compared.Results(1)Compared with simple PTC,higher proportions of females and microcarcinoma were noted among PTC patients complicated with HT while the differences in age,tumor size,multiple lesions and metastasis rate of lymph nodules were not statistically significant(P>0.05).(2)The differences between the two groups in ultrasonographic characteristics of PTC including structure,internal echo,form,edge,calcification and halo sign had no statistical significance(P>0.05).(3)There was generally no blood flow inside the PTC combined with HT while most simple PTCs had blood flow inside.Intranodular vascularity was rarely seen in PTCs of diameter≤10 mm,but very common in PTCs of diameter>10 mm.Conclusion PTC complicated with HT is more common among females,mostly microcarcinoma,with typical grey scale ultrasonic feature of PTC.Color Doppler imaging shows no intranodular vascularity in most cases.Intranodular vascularity in PTC is not only associated with the size of PTC but may also associate with the existence of HT.