甲状腺结节细针穿刺结合超声造影对早期甲状腺微小癌的诊断价值

Diagnosed values of fine needle aspiration combined with contrast-enhanced ultrasonography in the diagnosis of early thyroid microcarcinoma

目的探讨甲状腺结节超声评估系统(thyroid imaging reporting and data system,TI-RADS)、超声造影以及超声引导结节细针穿刺细胞学检查(fine needle aspiration cytology,FNAC)和肿瘤增殖相关基因对早期诊断甲状腺微小乳头状癌(thyroid micro-papillary carcinoma,PTMC)的准确性,评估早期转移风险。方法回顾性总结2018年5月至2019年5月上海中医药大学附属第七人民医院收治的行手术切除病理确诊甲状腺微小结节良、恶性患者共140例的临床资料,其中良性组90例和恶性组50例。比较恶性组和良性组患者TI-RADS分级、CEUS增强模式、定量评估软件测量结节峰值强度及RT-PCR法定量检测细胞中细胞周期蛋白D1(cyclin D1,CCND1)、细胞核增殖抗原(cell nuclear proliferating antigen,PCNA)和血管内皮生长因子(vascular endothelial growth factor,VEGF)mRNA表达水平。并评估恶性组患者FNAC阳性率、肿瘤TNM分期、包膜侵犯、淋巴结转移符合率。结果恶性组TI-RADS分级4级以上构成比显著高于良性组[92.0%(46/50)与5.6%(5/90),χ^2=103.718,P<0.001];CEUS增强模式以早期低增强为主[86.0%(43/50)与6.7%(6/90),χ^2=91.328,P<0.001],峰值强度值高于良性组[(6.79±1.88)与(5.32±1.46),t=4.968,P=0.008]。恶性组FNAC阳性率为92.0%(46/50)。FNAC阳性:肿瘤TNM分期42例,包膜侵犯9例,淋巴结转移6例;手术切除后病理阳性:肿瘤TNM分期50例,包膜侵犯10例,淋巴结转移6例。恶性组CCND1、PCNA和VEGF mRNA表达水平显著高于良性组[(0.562±0.134)与(0.213±0.097),t=15.639,P<0.001;(0.453±0.126)与(0.186±0.056),t=20.253,P<0.001;(0.633±0.159)与(0.252±0.097),t=31.265,P<0.001]。结论超声引导FNAC判断肿瘤TNM分期、包膜侵犯和淋巴结转移,同时检测CCND1、PCNA和VEGF表达水平以及超声造影显示结节增强模式、定量评估软件测量峰值强度值对早期诊断PTMC有较好的准确性,与手术病理结果有较好的一致性。

Objective To analyze the role of thyroid imaging reporting and data system(TI-RADS),contrast-enhanced ultrasound(CEUS),fine needle aspiration cytology(FNAC)and tumor proliferation related genes in the early diagnosis of thyroid micro-papillary carcinoma(PTMC)and risk assessment of early metastasis.Methods From May 2018 to May 2019,a total of 140 patients with Thyroid micronodules for surgical resection and pathological diagnosis of benign or malignant into the Seventh People′s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine for the retrospective study.There were 90 cases in benign group and 50 cases in malignant group.The levels of TI-RADS,CEUS enhancement mode,peak intensity(PI)and cyclin D1(CCND1),cell nuclear Proliferating Antigen(PCNA)and vascular endothelial growth factor(VEGF)were compared between malignant and benign groups,(VEGF)mRNA expression level.The positive rate of FNAC,TNM stage,capsule invasion and lymph node metastasis were evaluated.Results The percentage of class four and more by TI-RADS grade in malignant group was significantly more than benign group(92.0%(46/50)vs.5.6%(5/90),χ^2=103.718,P<0.001),more early low enhancement by CEUS(86.0%(43/50)VS.6.7%(6/90),χ^2=91.328,P<0.001)and PI value higher than benign group,too((6.79±1.88)VS.(5.32±1.46),t=4.968,P=0.008).The positive rate of FNAC in malignant group was 92.0%(46/50).FNAC was positive in 42 cases of TNM stage,9 cases of capsule invasion and 6 cases of lymph node metastasis.The pathological positive rate after resection was 50 cases of TNM stage,10 cases of capsule invasion and 6 cases of lymph node metastasis.The expression of CCND1,PCNA and VEGF mRNA in malignant group was significantly higher than that in benign group((0.5624±0.134)VS.(0.213±0.097),t=15.639,P<0.001;(0.453±0.126)VS.(0.186±0.056),t=20.253,P<0.001;(0.633±0.159)VS.(0.252±0.097),t=31.265,P<0.001).Conclusion Ultrasound-guided FNAC is used to determine TNM staging,capsule invasion and lymph node metastasis,CCND1,PCNA and VEGF expression level,contrast-enhanced mode and peak intensity value measured by quantitative evaluation software have good accuracy for early diagnosis of PTMC,and are consistent with the pathological results of hand surgery.