超声特征鉴别甲状腺滤泡状癌与滤泡状腺瘤。
Ultrasonographic features for differentiating follicular thyroid carcinoma and follicular adenoma.
机构信息
Department of Surgery, National Taiwan University Hospital, Taiwan, ROC; Department of Traumatology, National Taiwan University Hospital, Taiwan, ROC.
Department of Surgery, National Taiwan University Hospital, Taiwan, ROC.
出版信息
Asian J Surg. 2020 Jan;43(1):339-346. doi: 10.1016/j.asjsur.2019.04.016. Epub 2019 Jun 8.
BACKGROUND
Preoperative differentiation of follicular thyroid carcinoma (FTC) from follicular adenoma (FA) remains an unsolved puzzle. Patients sometimes undergo unnecessary lobectomy for histology confirmation inevitably.
OBJECTIVE
In this retrospective study, we propose new gray-scale ultrasonographic (US) features that may help to differentiate FTC from FA.
METHOD
Medical charts and US images of follicular thyroid neoplasms were collected prospectively. Gray-scale US features including conventional parameters adding tubercle-in-nodule and trabecular formation were recorded.
RESULTS
The histopathologic diagnosis was FA in 139 and FTC in 49 patients. In patients with FTC, minimally invasive follicular carcinoma (MIFC) was seen in 36 patients and widely invasive follicular carcinoma (WIFC) in 13. The incidences of calcifications (p < 0.0001), tubercle-in-nodule signs (p < 0.0001), spiculated margins (p = 0.014), and trabecular formations (p = 0.03) were significantly higher in FTC. Tubercle-in-nodule (p < 0.01) and calcification (p < 0.001) were independent factors in the differentiation of FTC in multivariate analysis (area under the curve = 0.689).
CONCLUSIONS
US characteristics of tubercle-in-nodule in combination with calcification help to differentiate FTC from FA.
背景
术前区分滤泡状甲状腺癌（FTC）和滤泡状腺瘤（FA）仍然是一个悬而未决的问题。患者有时不可避免地需要进行组织学确认的不必要的叶切除术。
目的
在这项回顾性研究中，我们提出了新的灰阶超声（US）特征，可能有助于区分 FTC 和 FA。
方法
前瞻性收集滤泡性甲状腺肿瘤的病历和 US 图像。记录灰阶 US 特征，包括结节内结节和小梁形成等常规参数。
结果
组织病理学诊断为 FA 的患者 139 例，FTC 的患者 49 例。在 FTC 患者中，可见微小侵袭性滤泡癌（MIFC）36 例，广泛侵袭性滤泡癌（WIFC）13 例。钙化（p<0.0001）、结节内结节征（p<0.0001）、刺状边缘（p=0.014）和小梁形成（p=0.03）的发生率在 FTC 中显著更高。在多因素分析中，结节内结节（p<0.01）和钙化（p<0.001）是 FTC 鉴别诊断的独立因素（曲线下面积=0.689）。
结论
US 特征中结节内结节伴钙化有助于区分 FTC 和 FA。
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