Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Korean J Radiol. 2024 Jan;25(1):103-112. doi: 10.3348/kjr.2023.0461.
To investigate the association of ultrasound (US) features of follicular thyroid carcinoma (FTC) with tumor invasiveness and prognosis based on the World Health Organization (WHO) classification and telomerase reverse transcriptase (TERT) promoter mutations.
This retrospective study included 54 surgically confirmed FTC patients with US images and TERT promoter mutations (41 females and 13 males; median age [interquartile range], 40 years [30-51 years]). The WHO classification consisted of minimally invasive (MI), encapsulated angioinvasive (EA), and widely invasive (WI) FTCs. Alternative classifications included Group 1 (MI-FTC and EA-FTC with wild type TERT), Group 2 (WI-FTC with wild type TERT), and Group 3 (EA-FTC and WI-FTC with mutant TERT). Each nodule was categorized according to the US patterns of the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and American College of Radiology-TIRADS (ACR-TIRADS). The Jonckheere-Terpstra and Cochran-Armitage tests were used for statistical analysis.
Among 54 patients, 29 (53.7%) had MI-FTC, 16 (29.6%) had EA-FTC, and nine (16.7%) had WI-FTC. In both the classifications, lobulation, irregular margins, and final assessment categories showed significant differences (all ≤ 0.04). Furthermore, the incidences of lobulation, irregular margin, and high suspicion category tended to increase with increasing tumor invasiveness and worse prognosis (all for trend ≤ 0.006). In the WHO groups, hypoechogenicity differed significantly among the groups ( = 0.01) and tended to increase in proportion as tumor invasiveness increased ( for trend = 0.02). In the alternative group, punctate echogenic foci were associated with prognosis ( = 0.03, for trend = 0.03).
Increasing tumor invasiveness and worsening prognosis in FTC based on the WHO classification and TERT promoter mutation results were positively correlated with US features that indicate malignant probability according to both K-TIRADS and ACR-TIRADS.
基于世界卫生组织（WHO）分类和端粒酶逆转录酶（TERT）启动子突变，研究滤泡状甲状腺癌（FTC）的超声（US）特征与肿瘤侵袭性和预后的关系。
本回顾性研究纳入 54 例经手术证实的 FTC 患者，均有 US 图像和 TERT 启动子突变（41 名女性，13 名男性；中位年龄[四分位数范围]，40 岁[30-51 岁]）。WHO 分类包括微侵袭性（MI）、包裹性血管侵袭性（EA）和广泛侵袭性（WI）FTC。替代分类包括 1 组（MI-FTC 和 EA-FTC 伴野生型 TERT）、2 组（WI-FTC 伴野生型 TERT）和 3 组（EA-FTC 和 WI-FTC 伴突变型 TERT）。根据韩国甲状腺影像报告和数据系统（K-TIRADS）和美国放射学院-TIRADS（ACR-TIRADS）的 US 模式对每个结节进行分类。Jonckheere-Terpstra 和 Cochran-Armitage 检验用于统计分析。
在 54 例患者中，29 例（53.7%）为 MI-FTC，16 例（29.6%）为 EA-FTC，9 例（16.7%）为 WI-FTC。在两种分类中，分叶、不规则边缘和最终评估类别均有显著差异（均 ≤0.04）。此外，随着肿瘤侵袭性的增加和预后的恶化，分叶、不规则边缘和高度可疑类别出现的比例呈增加趋势（所有趋势 ≤0.006）。在 WHO 组中，各组之间的低回声差异有统计学意义（ =0.01），随着肿瘤侵袭性的增加，这种差异呈增加趋势（趋势 =0.02）。在替代组中，点状强回声灶与预后相关（ =0.03，趋势 =0.03）。
根据 WHO 分类和 TERT 启动子突变结果，FTC 的肿瘤侵袭性增加和预后恶化与 K-TIRADS 和 ACR-TIRADS 均提示恶性概率的 US 特征呈正相关。
