2 cm以上的C-TI-RADS 3类甲状腺结节的临床特点分析

Clinical characteristics of C-TI-RADS 3 thyroid nodules measuring more than 2 cm

目的统计2 cm以上的中国版甲状腺影像报告及数据系统(C-TI-RADS)3类甲状腺结节的临床特点,并探究其与性别、结节成分、对侧是否有癌、是否弥漫性回声改变、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAB)、甲状腺球蛋白抗体(anti-thyroglobulin antibodies,TGAB)等的相关性。方法回顾性分析2022年9月-2023年3月我科收治的甲状腺超声C-TI-RADS 3类且最大直径≥2 cm的94例甲状腺结节患者(均接受细胞病理和/或组织病理检查)的临床病理学信息。统计TBSⅠ类、良性、低风险肿瘤、恶性的比例,并比较性别、结节成分、对侧是否有癌、是否弥漫性回声改变、TPOAB、TGAB等临床特点在良性、低风险肿瘤、恶性三组中的比例有无统计学差异。结果排除7例TBSⅠ类患者,87例结节病理明确患者中,良性72例(细胞学38例、组织学34例)、低风险肿瘤5例(细胞学2例、组织学3例)、恶性10例(PTC 8例、FTC 1例、MTC 1例)。不同病理类型之间,结节成分(囊实性/实性)组间差异具有显著性,差异有统计学意义(χ^(2)=10.369,P=0.006);性别、是否弥漫性回声改变、对侧是否有癌、TPOAB、TGAB组间差异无统计学意义(P均>0.05)。进一步分析结节成分与病理类型的关系,结果表明,低风险肿瘤相对于良性结节实性比例更高,差异有统计学意义(χ^(2)=9.571,P=0.002);而恶性结节相对于低风险肿瘤(χ^(2)=2.143,P=0.143),恶性结节相对于良性结节(χ^(2)=2.165,P=0.141)囊实性比例差异均无统计学意义。结论虽然各种版本的甲状腺影像报告与数据系统均将TI-RADS 3级结节认定为良性可能,但恶性结节在C-TI-RADS 3类甲状腺结节中仍占一定比例,需要重视诸如囊实性结节、甲状腺滤泡性肿瘤、甲状腺髓样癌等超声征象不典型的甲状腺结节。在评估结节良恶性时,超声引导下细针穿刺细胞病理学检查是必要的,需要重视标本不满意或无法诊断的情况,提高诊断的准确性。

Objective To analyze the clinical characteristics of C-TI-RADS 3 thyroid nodules with a diameter greater than 2 cm and explore their correlation with gender,nodule ingredient,contralateral cancer presence,diffuse echo changes,TPOAB and TGAB.Methods A retrospective analysis was made on the clinical and pathological information of 94 patients with thyroid nodules who were admitted to our department from September 2022 to March 2023.All the patients underwent cytological and/or histopathological examinations.The proportions of TBS I category,benign tumors,low-risk tumors,and malignant tumors were calculated.The proportion of TBS type I,benign tumors,low-risk tumors,and malignant tumors was quantified.Subsequently,a comparative analysis was conducted among the benign,low-risk,and malignant groups in terms of clinical characteristics including gender distribution,nodule composition,contralateral cancer occurrence,diffuse echo changes presence,as well as TPOAB and TGAB levels.We determined whether clinical characteristics such as gender,nodule composition,whether there is a cancer on the contralateral side,diffuse echo change,TPOAB and TGAB,respectively,have statistical significance in malignance ratio in the benign,low-risk,and tumor groups.Results Seven cases in TBS I category were excluded.Among the remaining 87 cases with confirmed pathology results for nodules,there were 72 benign cases(38 cytology cases and 34 histology cases),5 low-risk thyroid tumors(2 cytology cases and 3 histology cases),10 malignant cases(8 PTC cases,1 FTC case,and 1 MTC case).There was a significant difference in nodule ingredient(cystic/solid)between different pathological types(χ^(2)=10.369,P=0.006).However,no statistical significance was found in terms of gender,diffuse echo changes,contralateral cancer presence,TPOAB or TGAB(P>0.05).Further analysis showed that the proportion of solid component was higher in low-risk tumors than in benign nodules(χ^(2)=9.571,P=0.002).No statistical significance was found between malignant nodules and low-risk nodules(χ^(2)=2.143,P=0.143),or between malignant nodules and benign nodules(χ^(2)=2.165,P=0.141).Conclusion Although TI-RADS 3 nodules are generally considered as potentially benign according to various versions of thyroid imaging reporting and data system,malignant nodules still account for a certain proportion.Attention should be paid to thyroid nodules with a typical ultrasonic signs,such as cystic nodules,thyroid follicular tumors and medullary thyroid carcinoma.Ultrasound guided fine needle aspiration cytopathology is necessary for evaluating benign and malignant nodules.It is necessary to pay attention to unsatisfactory or undiagnosable specimens to improve the accuracy of diagnosis.