甲状腺髓样癌的C-TIRADS分类价值的探讨

Study on the value of C-TIRADS classification in medullary thyroid carcinoma

目的探讨甲状腺髓样癌的临床和超声检查特征,并用甲状腺结节超声检查恶性危险分层的中国指南(C-TIRADS)做评估。方法选取58例经病理证实为甲状腺髓样癌患者(72个结节)的临床和超声表现。超声评估指标包括:最大径、方位、内部结构、内部回声、钙化、边缘和点状强回声(彗星尾征)。超声指标纳入C-TIRADS分类,均与63例甲状腺乳头状癌(72个结节)作比较。结果甲状腺髓样癌降钙素和癌胚抗原明显高于甲状腺乳头状癌,差异有统计学意义(P<0.05)。大多数髓样癌表现为水平位、实性结构、非极低回声、无微钙化、边缘规则、无彗星尾征。髓样癌与乳头状癌C-TIRADS差异有统计学意义(P<0.05),髓样癌C-TIRADS 4A类多于乳头状癌,而4C类少于乳头状癌,差异有统计学意义(P<0.05),≤1.0 cm与>1 cm的髓样癌C-TIRADS分类差异无统计学意义(P>0.05)。结论甲状腺髓样癌与乳头状癌超声特征及C-TIRADS分类有所不同,联合血清降钙素和癌胚抗原检测有助于提高甲状腺髓样癌诊断的准确性。

Objective To investigate the clinical and sonographic features of medullary thyroid carcinoma(MTC),and to evaluate MTC by Chinese thyroid ultrasound imaging report and data system(C-TIRADS).Methods A total of 72 MTC nodules confirmed by postoperative pathology were analyzed retrospectively.Sonographic features including maximum diameter,orientation,composition,echogenicity,echogenic foci,margin,comet-tail artifacts were assessed,and the malignant characteristics were incorporated into the C-TIRADS,which were compared with 72 papillary thyroid carcinomas(PTC).Results Serum calcitonin and carcinoembryonic antigen(CEA)of MTCs were significantly higher than that of PTCs(P<0.05).Most of MTCs showed horizontal,solid nodule,circumscribed margin,no markedly hypoechoic,no microcalcifications and no comet-tail artifacts.Compared with PTC,there were more MTCs with C-TIRADS 4A,however,C-TIRADS 4C was more frequently observed in PTCs.There was statistically different in C-TIRADS classification between MTCs and PTCs(P<0.05),but no difference was detected in C-TIRADS classification between MTC≤10 mm and MTC>10 mm(P>0.05).Conclusion Compared with PTC,MTC had different sonographic features and C-TIRADS classification.Combined with serum calcitonin and CEA may be helpful to improve the accuracy of diagnosis of MTC.