甲状腺髓样癌的超声特征分析

Ultrasound characteristics of medullary thyroid carcinoma

目的分析甲状腺髓样癌(MTC)的超声特征,为MTC的诊断和术前管理提供参考。方法回顾性选取中国科学院大学附属肿瘤医院(浙江省肿瘤医院)2009年10月至2020年2月超声图文及临床病例资料完整的85例MTC患者,并选取同期的150例甲状腺乳头状癌(PTC)患者作为对照组,所有患者于本院行手术治疗并经术后常规病理确诊。收集患者术前血清降钙素检查结果。采用t检验比较2组患者年龄、结节大小的差异;采用χ^(2)检验比较2组患者性别、边缘、形态、血供及颈部转移性淋巴结等方面特征的差异,单因素分析差异有统计学意义的因素,采用Logistic回归分析进行多因素分析。结果97.0%(65/67)的MTC患者血清降钙素有不同程度升高。MTC与PTC在性别(男/女:46/39 vs 46/104)、年龄[(50.11±13.34)岁vs(43.63±11.88)岁]、结节大小[(21.66±13.46)mm vs(14.10±9.93)mm]方面比较,差异均具有统计学意义(χ^(2)=12.525、t=3.838、t=4.916,P均<0.001),2组患者在结节边缘(光整/不光整:56/29 vs 19/131)、形态(规则/不规则:34/51 vs 101/49)、纵横比(>1/≤1:10/75 vs 46/104)、血供(低/高:20/65 vs 65/85)、颈部淋巴结转移(是/否:57/28 vs 75/75)方面比较,差异均具有统计学意义(χ^(2)=70.709、16.582、10.679、9.217、6.413,P<0.001、<0.001、=0.001、=0.002、=0.011)。多因素Logistic回归分析显示:肿瘤边缘光整、形态不规则、易发生颈部淋巴结转移为独立危险因素(OR=34.786,95%CI:12.552~96.405,P<0.001;OR=0.194,95%CI:0.082~0.457,P<0.001;OR=0.277,95%CI:0.109~0.705,P<0.001)。结论MTC具有肿块较大、边缘光整、形态不规则、血供丰富、纵横比≤1、易发生颈部淋巴结转移的特点,结合血清降钙素可提高诊断准确率。

Objective To analyze the ultrasound characteristics of medullary thyroid carcinoma(MTC),in order to provide a reference for the diagnosis and preoperative management of MTC.Methods Eighty-five MTC patients with complete ultrasound and clinical data were retrospectively selected from the Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital)from October 2009 to February 2020,and 150 PTC patients were selected from October 2019 to February 2020 as a control group.All patients underwent surgical treatment at our hospital and were diagnosed by routine pathology after surgery.Preoperative serum calcitonin test results were collected.The t-test was used to compare the differences in age and nodule size between the two groups;theχ^(2) test was used to compare the differences in gender,edges,morphology,blood supply,and neck metastatic lymph nodes between the two groups.Factors with a statistically significant difference in univariate analysis were used for multivariate logistic regression analysis.Results Approximately 97.0%(65/67)of MTC patients had increased serum calcitonin to varying degrees.MTC and PTC were significantly related to gender(male/female:46/39 vs 46/104,χ^(2)=12.525,P<0.001),age[(50.11±13.34)years vs(43.63±11.88)years,t=3.838,P<0.001],and nodule size[(21.66±13.46)mm vs(14.10±9.93)mm,t=4.916,P<0.001],and the two groups differed significantly in nodule edges(smoothed/unsmoothed:56/29 vs 19/131,χ^(2)=70.709,P<0.001),shape(regular/irregular:34/51 vs 101/49,χ^(2)=16.582,P<0.001),aspect ratio(>1/≤1:10/75 vs 46/104,χ^(2)=10.679,P=0.001),blood supply(low/high:20/65 vs 65/85,χ^(2)=9.217,P=0.002),and lymph node metastasis(yes/no:57/28 vs 75/75,χ^(2)=6.413,P=0.011).Multivariate logistic regression analysis showed that smooth tumor edges,irregular shape,and neck lymph node metastasis were independent risk factors(OR=34.786,95%CI:12.552-96.405,P<0.001;OR=0.194,95%CI:0.082-0.457,P<0.001;OR=0.277,95%CI:0.109-0.705,P<0.001).Conclusion MTC has the characteristics of being a large mass,smooth edges,irregular shape,rich blood supply,aspect ratio≤1,and being prone to neck lymph node metastasis.Combined serum calcitonin can improve the diagnostic accuracy.