Fang Cheng, Konstantatou Eleni, Mulholland Nicola J, Baroncini Serena, Husainy Mohammad A, Schulte Klaus-Martin, Sidhu Paul S
Department of Radiology, King's College Hospital NHS Foundation Trust London, London, UK.
Ultrasound. 2018 May;26(2):110-117. doi: 10.1177/1742271X18758516. Epub 2018 Feb 10.
To identify the variant features encountered in parathyroid abnormalities and document those suggesting malignant change.
Data were collected from a cohort of patients who underwent investigation for primary hyperparathyroidism over a 10-year period. Ultrasonographic features: shape, presence of calcification, cystic changes, heterogeneous echogenicity, vascularity, capsular thickening, local invasion, and vascularity were reviewed retrospectively and were used to correlate with final histological findings.
One hundred forty-seven patients with histology and concurrent ultrasonographic scans were reviewed, and divided into benign parathyroid lesions (nodular hyperplasia ( = 44), adenoma ( = 93)) and parathyroid carcinoma ( = 10). Parathyroid carcinomas were significantly larger than benign parathyroid lesions ( = 0.030). Benign parathyroid lesions showed variant sonographic features: irregular shape (16.8%), heterogenous echogenicity (24.1%), calcification (1.5%), capsular thickening (1.5%), and cystic change (19.7%). A significantly higher proportion of parathyroid carcinomas demonstrated heterogenous echogenicity ( = 0.022), capsular thickening ( = 0.023), and infiltrative margin ( < 0.0001) than benign parathyroid lesions. Of the 137 benign parathyroid lesions, 38 (27.7%), 76 (55.5%), 23 (16.8%) were avascular, vascular, and hypervascular, respectively. Of the 10 parathyroid carcinomas, 4 (40%), 3 (30%), and 3 (30%) of lesions were avascular, vascular, and hypervascular, respectively. The vascularity of the lesions did not differ significantly between the parathyroid carcinoma and benign parathyroid lesions ( = 0.281).
Ultrasonographic features such as irregular shape, heterogeneous echogenicity, cystic change, and vascularity are nondiscriminatory features between benign or malignant lesions. Large lesion size together with the presence of calcification, capsular thickening, or infiltrative margin strongly raises the suspicion of a malignant parathyroid lesion, and management should be altered.
识别甲状旁腺异常中遇到的变异特征，并记录那些提示恶性改变的特征。
收集了一组在10年期间接受原发性甲状旁腺功能亢进症检查的患者的数据。回顾性分析超声特征：形状、钙化情况、囊性改变、回声不均匀、血管情况、包膜增厚、局部侵犯及血管分布，并将其与最终的组织学结果进行关联。
对147例有组织学检查及同期超声扫描的患者进行了回顾性分析，分为良性甲状旁腺病变（结节性增生（n = 44），腺瘤（n = 93））和甲状旁腺癌（n = 10）。甲状旁腺癌明显大于良性甲状旁腺病变（P = 0.030）。良性甲状旁腺病变表现出多种超声特征：不规则形状（16.8%）、回声不均匀（24.1%）、钙化（1.5%）、包膜增厚（1.5%）及囊性改变（19.7%）。与良性甲状旁腺病变相比，甲状旁腺癌表现出回声不均匀（P = 0.022）、包膜增厚（P = 0.023）及浸润性边缘（P < 0.0001）的比例明显更高。在137例良性甲状旁腺病变中，分别有38例（27.7%）、76例（55.5%）、23例（16.8%）为无血管、有血管及血管丰富型。在10例甲状旁腺癌中，分别有4例（40%）、3例（30%）、3例（30%）为无血管、有血管及血管丰富型。甲状旁腺癌与良性甲状旁腺病变之间病变的血管分布无明显差异（P = 0.281）。
诸如不规则形状、回声不均匀、囊性改变及血管分布等超声特征在良性或恶性病变之间并无鉴别意义。病变较大且伴有钙化、包膜增厚或浸润性边缘强烈提示甲状旁腺恶性病变，应改变处理方式。
