Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Ultrasound, Beijing Haidian Hospital, Haidian Section of Peking University Third Hospital, Beijing 100080, China.
Chin Med J (Engl). 2019 Apr 5;132(7):834-841. doi: 10.1097/CM9.0000000000000160.
Medullary thyroid carcinoma (MTC) is a rare disease, but it exhibits more aggressive behaviors. The aim of this study was to improve the diagnostic accuracy of MTC before surgery by analyzing the clinical and ultrasonic data of patients with MTC.
The study included 71 patients (96 lesions) with histopathologically proven MTC between April 2011 and September 2016 in the Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College. The clinical characteristics and sonographic findings were retrospectively reviewed and compared between the ultrasonic correct diagnosis group and the ultrasonic misdiagnosis group with the t test or Mann-Whitney U test for quantitative parameters and the χ test or Fisher exact test for qualitative parameters.
Compared with the ultrasonic correct diagnosis group, the proportion of the cystic change in the ultrasonic misdiagnosed group was high (25.0% vs. 4.2%), the uncircumscribed margin and irregular shape proportions were low (20.8%, 58.3% vs. 74.7%, 87.3%), calcification was relatively rare (20.8% vs. 56.3%), and rich vascularity was relatively rare (25.0% vs. 78.9%).
In the case of atypical MTC, such as cystic change, circumscribed margin, regular shape, no calcification, no rich vascularity, and normal cervical lymph nodes, MTC is easily misdiagnosed as benign by ultrasound. Therefore, ultrasound, cytology and serum calcitonin should be comprehensively evaluated for a preoperative diagnosis of MTC.
甲状腺髓样癌（MTC）是一种罕见疾病，但它表现出更具侵袭性的行为。本研究旨在通过分析 MTC 患者的临床和超声数据，提高术前 MTC 的诊断准确性。
本研究纳入了 2011 年 4 月至 2016 年 9 月在中国医学科学院肿瘤医院和北京协和医学院接受手术治疗且经病理证实为 MTC 的 71 例（96 个病灶）患者。回顾性分析并比较了超声正确诊断组和超声误诊组的临床特征和超声表现，对定量参数采用 t 检验或 Mann-Whitney U 检验，对定性参数采用 χ 检验或 Fisher 确切概率法。
与超声正确诊断组相比，超声误诊组的囊性变比例较高（25.0% vs. 4.2%），无边界和不规则形状的比例较低（20.8%，58.3% vs. 74.7%，87.3%），钙化相对少见（20.8% vs. 56.3%），血流丰富相对少见（25.0% vs. 78.9%）。
对于不典型的 MTC，如囊性变、边界清晰、形状规则、无钙化、无丰富血流和正常颈部淋巴结，超声容易误诊为良性。因此，术前诊断 MTC 时应综合评估超声、细胞学和血清降钙素。
