常规超声及甲状腺球蛋白检测诊断甲状腺滤泡癌的价值

Value of conventional ultrasound and preoperative serum thyroglobulin level in diagnosis of thyroid follicular carcinoma

目的:探讨能否通过超声声像图特征和血清甲状腺球蛋白鉴别甲状腺滤泡癌(follicular thyroid carcinoma,FTC)与甲状腺腺瘤(thyroid adenoma,TA)。方法:对手术后病理学检查证实的55例FTC患者的56个结节和78例TA患者的88个结节的临床特征及超声声像图资料进行回顾性分析,比较FTC与TA间各参数的差别。结果:FTC组术前血清球蛋白水平高于TA组(P<0.05),诊断的最佳阈值为98.38 ng/mL。FTC常结节更大,内部回声多不均匀,多呈实性,周围多无晕环或晕环厚薄不均,内部可见钙化(P<0.05);而TA结节相对较小,内部回声多均匀,囊实性多见,周围多表现为无或存在厚薄均匀的细晕,内部多无钙化灶(P<0.05)。结节最大径的最佳诊断阈值为30.50 mm。在年龄、性别、术前血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)水平、游离四碘甲状腺原氨酸(free tetraiodothyronine,FT4)水平、促甲状腺激素(thyroid stimulating hormone,TSH)水平、甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)水平、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)水平、回声水平、位置、形态、边界、血流分布、收缩期峰值流速(peak systolic velocity,PSV)、舒张末期流速(end diastolic velocity,EDV)及阻力指数(resistance index,RI)方面两组间差异无统计学意义。结论:甲状腺超声检查时发现无囊性变、内部回声不均匀且大于3 cm的实性结节,周边无或有厚薄不均的晕环,内部可见钙化,伴血清甲状腺球蛋白升高,应警惕FTC的可能。

Objective: To investigate the value of ultrasonographic features and preoperative serum thyroglobulin(Tg) level in the differential diagnosis of thyroid follicular carcinoma(FTC) from thyroid adenoma(TA). Methods: Clinical data and ultrasonographic features of 56 FTC nodules in 55 patients and 88 TA nodules in 78 patients were retrospectively analyzed and compared. Results:Preoperative serum Tg level was higher in FTC(P<0.05), with the cut-off value of 98.38 ng/mL. Larger size, heterogeneous echo,solid contents, without or with irregular halo and presence of calcifications were associated with FTC(P<0.05). The cut-off value of maximum diameter was 30.50 mm. In comparison, TA were more likely presented with smaller size, homogeneous echo, cyst changes, without or with regular thin halo and absence of calcifications(P<0.05). There was no significant difference in sex, age,free triiodothyronine(FT3), free tetraiodothyronine(FT4), thyroid stimulating hormone(TSH), thyroglobulin antibody(TgAb),thyroid peroxidase antibody(TPOAb), echogenecity, position, shape, margin, vascularity features, peak systolic velocity(PSV),end diastolic velocity(EDV), resistance index(RI)(P>0.05). Conclusion: Large nodules over 3 cm without cyst changes, but with heterogeneous echo and calcifications, without or with irregular halo found during thyroid ultrasound examination, combined with elevated serum Tg level, mean that the possibility of FTC should be taken into consideration.