甲状腺手术“偶然”检出73例微小乳头状癌的回顾性分析

Retrospective analysis 73 cases of incidental papillary thyroid microcarcinoma on presumed benign thyroid diseases

【目的】分析甲状腺微小乳头状癌(PTMC)在行良性甲状腺疾病(BTD)手术中的“偶然”检出率,及其与患者年龄、性别、合并发生的甲状腺病变类型的关系,以期发现PTMC的潜在预测因素。【方法】收集本院2015年1月1日至2015年12月31日期间因甲状腺疾病行外科手术治疗的共939名患者的病例资料,回顾性分析其临床病理特点。【结果】939名患者中男性194名(20.7%),女性745名(79.3%);年龄范围11~84岁。73名经病理切片确诊为PTMC,男性15名(7.1%),女性58名(7.5%);年龄范围18~66岁。采用Pearson卡方检验,PTMC的总“偶然”检出率为7.8%,且与患者年龄、性别的关联无统计学意义(P>0.05)。73名PTMC患者中26名无合并良性病变;33名合并结节性甲状腺肿;6名合并慢性淋巴细胞性甲状腺炎;2名合并毒性结节性/弥漫性甲状腺肿。采用单变量logistic回归分析,结节性甲状腺肿(OR=0.115,95%CI=0.064-0.206,P<0.001)是“偶然”检出率的阴性预测因素,毒性结节性/弥漫性甲状腺肿(OR=0.085,95%CI=0.019-0.379,P=0.001)是“偶然”检出率的阴性预测因素,差异均有统计学意义(P<0.001)。采用多变量logistic回归分析,结节性甲状腺肿(OR=0.102,95%CI=0.055-0.189,P<0.001)和毒性结节性/弥漫性甲状腺肿(OR=0.090,95%CI=0.020-0.401,P=0.002)可视为PTMC独立的潜在阴性预测因素,差异均有统计学意义(P<0.001)。【结论】PTMC“偶然”检出率与患者年龄、性别均无关。结节性甲状腺肿合并PTMC的检出率在所有甲状腺病变中最高,而毒性结节性/弥漫性甲状腺肿合并PTMC最低。结节性甲状腺肿和毒性结节性/弥漫性甲状腺肿可视为PTMC独立的潜在阴性预测因素。

【Objective】The aim of this study was to retrospectively investigate the incidence of papillary thyroid microcarcinoma(PTMC)in patients operating for presumed benign thyroid disease(BTD)and its relation to age,sex,and types of benign thyroid lesions,to determine potential independent predictors for PTMC.【Methods】A total number of 939 patients who underwent thyroid surgery during the year 2015 were enrolled in the study,a retrospective analysis was conducted to assess their clinical and pathological characteristics.【Results】In totle 939 cases there were 194(20.7%)males and 745(79.3%)females,age ranged from 11 to 84 years.In 73 cases of PTMC there were 15(7.1%)males and 58(7.5%)females,age ranged from 18 to 66 years.The overall incidence of PTMC was 7.8%.According to Pearson's Chi-Square test,sex and age were not significantly related to the incidence of PTMC(P>0.05).According to univariate logistic regression,the highest incidence of PTMC was in multinodular goiter(OR=0.115,95%CI=0.064-0.206,P<0.001),the lowest incidence of PTMC was in hyperfunctional thyroid nodule(OR=0.085,95%CI=0.019-0.379,P=0.001).According to multivariate logistic regression,multinodular goiter(OR=0.102,95%CI=0.055-0.189,P<0.001)and hyperfunctional thyroid nodule(OR=0.090,95%CI=0.020-0.401,P=0.002)can be considered as potential independent negative predictors for PTMC.【Conclusion】Sex and age are not statistically related to the incidence of PTMC in presumed benign thyroid diseases.The incidence of PTMC is highest in multinodular goitre and lowest in patients with Graves disease.It is acceptable that multinodular goitre and Graves disease can be considered as potential independent predictors of PTMC.