Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Korea.
Korean J Radiol. 2018 Jul-Aug;19(4):673-681. doi: 10.3348/kjr.2018.19.4.673. Epub 2018 Jun 14.
To determine the histopathologic features associated with ultrasonographic echogenicity of thyroid nodules.
This study included 95 nodules of 95 patients (76 women, 19 men; mean age 47.5 ± 12.9 years) with homogeneous echogenicity in which core needle biopsy was performed during a one year period. The nodule echogenicity was categorized into 4 grades (hyperechogenicity, isoechogenicity, mild hypoechogenicity, and marked hypoechogenicity). The biopsy specimens were evaluated by a pathologist regarding the histopathologic features of fibrosis, lymphoid infiltration, microfollicular pattern, uniform follicular pattern, and hypercellularity in nodules. We evaluated the association of each histopathologic feature among 3 categories of nodule echogenicity by multinomial regression analysis.
The nodule echogenicity was isoechoic in 28 (29.5%), mildly hypoechoic in 37 (38.9%), and markedly hypoechoic in 30 (31.6%), and there was no hyperechoic nodule. There was a trend of increasing frequency of fibrosis (> 30%) as nodule echogenicity decreased (isoechogenicity, 10.7%; mild hypoechogenicity, 32.4%; and marked hypoechogenicity, 80%; < 0.001). The microfollicular pattern, uniform follicular pattern, and hypercellularity were frequently found in mildly hypoechoic nodules than in isoechoic nodules ( ≤ 0.018). The fibrosis (> 30%) and hypercellularity were independently associated with mild or marked hypoechogenicity as compared to isoechogenicity (fibrosis; ≤ 0.004 and hypercellularity; ≤ 0.036), and only fibrosis (> 30%) was independently associated with marked hypoechogenicity as compared to mild hypoechogenicity ( = 0.004).
The fibrosis (> 30%) and high cellularity are independently associated with mild or marked hypoechogenicity of nodules. The knowledge of the relationship of echogenicity and histopathology of thyroid nodules could improve management of patients with thyroid nodules.
确定与甲状腺结节超声回声特征相关的组织病理学特征。
本研究纳入了 95 例患者（76 名女性，19 名男性；平均年龄 47.5±12.9 岁）的 95 个均质回声结节，在一年内进行了空心针活检。将结节回声分为 4 个等级（强回声、等回声、轻度低回声和明显低回声）。病理学家评估活检标本的纤维化、淋巴细胞浸润、微滤泡模式、均匀滤泡模式和结节内细胞增生等组织病理学特征。我们通过多项回归分析评估了 3 种结节回声类别中每个组织病理学特征之间的关系。
结节回声为等回声 28 个（29.5%）、轻度低回声 37 个（38.9%）、明显低回声 30 个（31.6%），无强回声结节。随着结节回声降低（等回声为 10.7%；轻度低回声为 32.4%；明显低回声为 80%； ＜0.001），纤维化（＞30%）的频率呈增加趋势。微滤泡模式、均匀滤泡模式和细胞增生在轻度低回声结节中比等回声结节中更常见（≤0.018）。与等回声相比，纤维化（＞30%）和细胞增生与轻度或明显低回声相关（纤维化； ＜0.004 和细胞增生； ＜0.036），而只有纤维化（＞30%）与明显低回声相关（ ＝0.004）。
纤维化（＞30%）和高细胞性与结节的轻度或明显低回声独立相关。了解回声特征与甲状腺结节组织病理学之间的关系，可以改善甲状腺结节患者的管理。
