Li Jia-Wei, Chang Cai, Chen Jia-Ying, Shi Zhao-Ting, Chen Min
Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; No 270, Dong'an Road, Xuhui District, Shanghai, China.
Curr Med Imaging Rev. 2019;15(5):489-495. doi: 10.2174/1573405614666180425142141.
To compare the abilities of ultrasonography (US) and Computed Tomography (CT) to identify calcifications and to predict probability of malignancy for Papillary Thyroid Carcinoma (PTC) and Papillary Thyroid Microcarcinoma (PTMC).
We reviewed 1008 cases of PTC/PTMC with calcifications reported by pre-operative US, CT, or post-operative pathology. The size of the thyroid nodule was obtained from the US report and the maximum diameter (d) was documented. According to the nodule size (d), the PTC and PTMC groups were each divided into two subgroups, as follows: large PTC group (d ≥ 2 cm), small PTC group (1 cm < d < 2 cm), large PTMC group (0.6 cm ≤ d ≤ 1 cm), and small PTMC group (d < 0.6 cm).
In the 1008 patients, the ratio of females to males was 2.29 and the mean age was 40.9 years (standard deviation: 11.7 years). Of the 1008 records, 92.8% were found to have calcifications according to the US report, while 50.4% showed calcifications according to the CT report. This difference between US and CT reports was statistically significant (p < 0.0005). The percentages of US reports showing calcifications were similar for all four PTC and PTMC subgroups (93.7%, 94.3%, 92.1%, and 85.1%, respectively; p = 0.052), while the percentages of CT reports showing calcifications were significantly different among the PTC and PTMC subgroups (62.3%, 52.2%, 45.4%, and 31.3%, respectively; p < 0.0005). As for the prediction of malignancy, US was superior to CT in all four subgroups (large PTC group: 97.1% vs. 54.1%, small PTC group: 94.8% vs. 42.9%, large PTMC group: 97.2% vs. 32.0%, small PTMC group: 95.5% vs. 14.9%; p < 0.0005 for all pairwise comparisons). No significant difference was observed in terms of the ability of US to predict the malignancy of PTC versus PTMC (p = 0.31), while CT showed significant superiority in diagnosing PTC versus PTMC (p < 0.0005). The predictive value of CT for PTC declined as the nodule size decreased (p < 0.05 for all pairwise comparisons).
Our results showed that US detected calcifications and predicted the malignancy of all nodule sizes of thyroid papillary carcinoma equally well, while the performance of CT declined with the reduction of nodule size.
比较超声（US）和计算机断层扫描（CT）识别钙化以及预测甲状腺乳头状癌（PTC）和甲状腺微小乳头状癌（PTMC）恶性概率的能力。
我们回顾了1008例术前经US、CT或术后病理报告有钙化的PTC/PTMC病例。甲状腺结节大小从US报告中获取，并记录最大直径（d）。根据结节大小（d），将PTC和PTMC组各分为两个亚组，如下：大PTC组（d≥2 cm）、小PTC组（1 cm＜d＜2 cm）、大PTMC组（0.6 cm≤d≤1 cm）和小PTMC组（d＜0.6 cm）。
1008例患者中，女性与男性比例为2.29，平均年龄为40.9岁（标准差：11.7岁）。在1008份记录中，根据US报告92.8%发现有钙化，而根据CT报告50.4%显示有钙化。US和CT报告之间的这种差异具有统计学意义（p＜0.0005）。所有四个PTC和PTMC亚组中US报告显示钙化的百分比相似（分别为93.7%、94.3%、92.1%和85.1%；p = 0.052），而PTC和PTMC亚组中CT报告显示钙化的百分比有显著差异（分别为62.3%、52.2%、45.4%和31.3%；p＜0.0005）。至于恶性预测，在所有四个亚组中US均优于CT（大PTC组：97.1%对54.1%，小PTC组：94.8%对42.9%，大PTMC组：97.2%对32.0%，小PTMC组：95.5%对14.9%；所有两两比较p＜0.0005）。在US预测PTC与PTMC恶性的能力方面未观察到显著差异（p = 0.31），而CT在诊断PTC与PTMC方面显示出显著优势（p＜0.0005）。CT对PTC的预测价值随着结节大小减小而下降（所有两两比较p＜0.05）。
我们的结果表明，US能很好地检测钙化并同等程度地预测甲状腺乳头状癌所有结节大小的恶性情况，而CT的性能随结节大小减小而下降。
