Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr., H1307, Stanford, CA 94105, USA.
AJR Am J Roentgenol. 2011 Jan;196(1):66-70. doi: 10.2214/AJR.10.4474.
The purpose of this article is to characterize sonographic features of differentiated thyroid cancer recurrence in the thyroidectomy bed.
Patients referred for biopsy of thyroidectomy bed lesions between February 2006 and December 2009 were identified. Patient data and gray-scale and color Doppler features were recorded.
Results of ultrasound-guided biopsies of 30 nodules in 27 patients were reviewed. Twenty-five lesions yielded diagnostic findings, including 22 recurrences in 19 patients and three benign lesions in three patients. Five biopsies were nondiagnostic. Among the 22 recurrences, 21 (95%) were hypoechoic and one (5%) was mixed hypoechoic and hyperechoic on gray-scale imaging. On Doppler imaging, 100% of recurrences had detectable vascularity. Eight lesions (36%) had microcalcifications, and five (23%) had coarse calcifications; the average long-axis dimension was 1.5 cm. Of the five nondiagnostic lesions, four (80%) were hypoechoic, one (20%) was isoechoic, one (20%) had microcalcifications, none had coarse calcifications, and two (40%) had vascularity; the average long-axis dimension was 0.6 cm. Of the negative lesions, three (100%) were hypoechoic, two (66%) had vascularity, and two (66%) had coarse calcifications. No microcalcifications were seen, and the average long-axis dimension was 2 cm. Serum thyroglobulin (Tg) or anti-Tg antibodies were elevated in 12 (63%) of 19 patients with recurrence (eight [42%] with elevated Tg levels and four [21%] with elevated anti-Tg antibody levels).
An ultrasound finding of a hypoechoic thyroidectomy bed lesion with internal vascularity and size greater than 6 mm is highly sensitive in predicting recurrence. Serum Tg levels were less sensitive than ultrasound in detection of recurrence in the thyroidectomy bed.
本文旨在描述甲状腺切除术后床复发的甲状腺分化癌的超声特征。
回顾性分析 2006 年 2 月至 2009 年 12 月期间因甲状腺床病变行超声引导活检的患者资料。记录患者数据及灰阶和彩色多普勒特征。
共对 27 例患者的 30 个结节的超声引导活检结果进行了回顾性分析。25 个病变获得了明确的诊断结果，其中 19 例患者的 22 个病变为复发，3 例患者的 3 个病变为良性病变。5 个活检结果为非诊断性的。在 22 个复发病例中，21 个（95%）为低回声，1 个（5%）为混合低回声和高回声。多普勒成像显示，100%的复发病例均有可检测到的血流。8 个病灶（36%）有微钙化，5 个（23%）有粗钙化；平均长轴尺寸为 1.5cm。5 个非诊断性病变中，4 个（80%）为低回声，1 个（20%）为等回声，1 个（20%）有微钙化，无粗钙化，2 个（40%）有血流；平均长轴尺寸为 0.6cm。阴性病变中，3 个（100%）为低回声，2 个（66%）有血流，2 个（66%）有粗钙化。未见微钙化，平均长轴尺寸为 2cm。19 例复发病例中，12 例（63%）患者血清甲状腺球蛋白（Tg）或抗 Tg 抗体升高（8 例[42%]Tg 水平升高，4 例[21%]抗 Tg 抗体水平升高）。
超声发现甲状腺切除术后床内回声低、有内部血流且大小大于 6mm 的病变高度提示复发。血清 Tg 水平在检测甲状腺切除术后床复发方面的敏感性不如超声。
