甲状腺结节良恶性的预测因素。

Dr Md Rafiqul Islam, Associate Professor, ENT and Head Neck Surgery, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:

Mymensingh Med J. 2022 Apr;31(2):372-378.

Thyroid swellings are common clinical problem throughout the world and also in Bangladesh. Most of thyroid swellings are multinodular, but a good percentage is solitary thyroid nodule. There is no robust, feasible method for malignancy differentiation has not been well established. The study evaluated thyroid nodules for risk of malignancy and compared history, clinical, sonographic features and FNAC findings with histopathology. This was a cross sectional study on 160 consecutive subjects of thyroid nodules done in the department of ENT and Head Neck Surgery of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh during from July 2018 to December 2019. All patients were admitted and diagnosed by detail history, clinical examination, investigations and underwent thyroidectomy. Detailed history, clinical examination, ultrasonographic finding and FNAC variables were documented retrospectively and a mathematical model was established for malignancy prediction. In this study mean age of the patients of thyroid nodules was 37.54±11.49 years and majority of the patients were within 21-40 years of age. Frequency of thyroid nodules is more in female with male female ratio 1:7. Most of the thyroid nodules appeared in this study within 0-2 years (61.9%). In this series of thyroid nodules constituted 88.1% firm, 8.8% hard, 3.1% cystic. Among the patients 89(55.6%) cases have solitary thyroid nodule and 71(44.4%) cases have multinodular goitre Majority of the nodules were warm 57.5% followed by cold 42.5%. FNAC showed nodular goitre 72.5%, Follicular neoplasm 1.3%, Papillary carcinoma of thyroid 7.5%, colloid goitre 9.4%, suspicious papillary carcinoma 3.8% and lymphocytic thyroiditis 1.3%. In this study out of 85 solid nodule, 69(81.18%) were benign and 16(18.82%) was malignant and out of 3 cystic nodule 3(100%) were benign. In this study most of the benign and malignant nodules were predominantly solid. Study showed the malignancy is significantly (p=0.001) more in solid than cystic nodules. Final diagnosis in this study was done on the basis of histopathological reports. Out of 160 patients, histopathologically benign lesion was 120(75%) and malignant was 40(25%). Among malignant cases 36(22.5%) cases were papillary carcinoma, 1 case was medullary carcinoma and 3 cases were follicular carcinoma.

甲状腺肿在全球范围内都是常见的临床问题，在孟加拉国也是如此。大多数甲状腺肿是多结节性的，但相当一部分是单发甲状腺结节。目前还没有一种稳健、可行的方法来区分良恶性，也没有得到很好的建立。本研究评估了甲状腺结节的恶性风险，并将病史、临床、超声特征和细针穿刺抽吸术（FNAC）结果与组织病理学进行了比较。这是一项在孟加拉国迈门辛医科大学医院耳鼻喉科和头颈部外科进行的 160 例连续甲状腺结节患者的横断面研究，时间为 2018 年 7 月至 2019 年 12 月。所有患者均住院并通过详细的病史、临床检查、检查进行诊断，并接受了甲状腺切除术。回顾性记录详细的病史、临床检查、超声发现和 FNAC 变量，并建立了用于恶性预测的数学模型。在这项研究中，甲状腺结节患者的平均年龄为 37.54±11.49 岁，大多数患者年龄在 21-40 岁之间。女性中甲状腺结节的发生率较高，男女比例为 1:7。本研究中大多数甲状腺结节出现在 0-2 年内（61.9%）。在本系列中，甲状腺结节构成 88.1%为实性，8.8%为硬实，3.1%为囊性。在患者中，89（55.6%）例为单发甲状腺结节，71（44.4%）例为多结节性甲状腺肿。大多数结节为温结节（57.5%），其次为冷结节（42.5%）。FNAC 显示结节性甲状腺肿 72.5%，滤泡性肿瘤 1.3%，甲状腺乳头状癌 7.5%，胶样甲状腺肿 9.4%，可疑乳头状癌 3.8%，淋巴细胞性甲状腺炎 1.3%。在本研究中，85 个实性结节中，69 个（81.18%）为良性，16 个（18.82%）为恶性，3 个囊性结节均为良性。在本研究中，大多数良性和恶性结节主要是实性的。研究表明，实性结节的恶性程度明显（p=0.001）高于囊性结节。本研究的最终诊断是基于组织病理学报告。在 160 名患者中，组织学上良性病变 120 例（75%），恶性病变 40 例（25%）。恶性病例中，36 例（22.5%）为乳头状癌，1 例为髓样癌，3 例为滤泡癌。