Department of Ultrasound, Peking University First Hospital, Beijing, China.
Department of Pathology, Peking University First Hospital, Beijing, China.
Front Endocrinol (Lausanne). 2024 Mar 1;14:1238775. doi: 10.3389/fendo.2023.1238775. eCollection 2023.
This study aimed to investigate the clinico-ultrasound features of primary squamous cell carcinoma of the thyroid (PSCCT) and secondary SCCT (SSCCT) and evaluate the accuracy of fine needle aspiration (FNA) recommendation for SCCT with American College of Radiology-Thyroid Imaging and Reporting Data System (ACR-TIRADS) and Chinese-TIRADS (C-TIRADS).
We retrieved 26 SCCT patients (11 PSCCT, 15 SSCCT) from our hospital's pathology database (5,718 patients with thyroid malignancy) over 23 years. Medical records and ultrasound data of the 26 patients with 27 SCCTs were analyzed retrospectively, and each SCCT focus was categorized based on the two TIRADSs.
For 26 patients (21 males, 5 females) with an age range of 42-81 years, rapidly enlarging thyroid/neck nodules (18/26, 69.2%), dysphagia (7/26, 26.9%), hoarseness (6/26, 23.1%), dyspnea (5/26, 19.6%), cough (4/26, 15.4%), neck pain (2/26, 7.7%), B symptoms (2/26, 7.7%), and blood in sputum (1/26, 3.8%) were presented at diagnosis. Five asymptomatic patients (5/26, 19.2%) were detected by ultrasound. Hoarseness was more common in PSCCT (5/11, 45.5%) than in SSCCT (1/15, 6.7%) (P=0.032). For 27 SCCTs with a mean size of 3.7 ± 1.3 cm, the ultrasound features consisted of solid (25/27, 92.6%) or almost completely solid composition (2/27, 7.4%), hypoechoic (17/27, 63%) and very hypoechoic echogenicity (10/27, 37%), irregular/lobulated margin with extra-thyroidal extension (27/27, 100%), taller-than-wide shape (13/27, 48.1%), punctate echogenic foci (6/27, 22.2%), hypervascularity (23/27, 85.2%) and involved neck lymph (13/26, 50.0%). A total of 27 SCCTs were evaluated as high malignancy risk stratification (≥TR4 and 4B) by the two TIRADSs and recommended FNA in 96.3-100% (26/27, 27/27). Pathologically, more than half of PSCCTs (7/12, 58.3%) and a quarter of SSCCTs (4/15, 26.7%) were poorly differentiated, while moderately and well-differentiated grades were observed in 5 PSCCTs and 11 SSCCTs (P=0.007). Thirteen patients (50.0%) underwent surgery with radical operation in 5 cases (5/13, 38.5%).
SCCT is an extremely rare and aggressive malignancy with a male predominance. PSCCT and SSCCT had similar clinical and ultrasound features except for tumor differentiation and the symptom of hoarseness. SCCT showed a high malignancy risk stratification in ACR-TIRADS and C-TIRADS, with a high rate of FNA recommendation.
本研究旨在探讨原发性甲状腺鳞状细胞癌（PSCCT）和继发性 SCCT（SSCCT）的临床-超声特征，并评估美国放射学院-甲状腺成像与报告数据系统（ACR-TIRADS）和中国 TIRADS（C-TIRADS）对 SCCT 细针穿刺（FNA）推荐的准确性。
我们从医院病理数据库（5718 例甲状腺恶性肿瘤患者）中检索了 23 年来的 26 例 SCCT 患者（11 例 PSCCT，15 例 SSCCT）。回顾性分析了 26 例患者的 27 个 SCCT 病灶的病历和超声资料，根据两种 TIRADS 对每个 SCCT 病灶进行分类。
26 例患者（男 21 例，女 5 例）年龄 42-81 岁，主要表现为甲状腺/颈部结节迅速增大（18/26，69.2%）、吞咽困难（7/26，26.9%）、声音嘶哑（6/26，23.1%）、呼吸困难（5/26，19.6%）、咳嗽（4/26，15.4%）、颈部疼痛（2/26，7.7%）、B 症状（2/26，7.7%）和痰中带血（1/26，3.8%）。5 例无症状患者（5/26，19.2%）通过超声发现。声音嘶哑在 PSCCT 中更为常见（5/11，45.5%），而在 SSCCT 中则不常见（1/15，6.7%）（P=0.032）。27 个 SCCT 的平均大小为 3.7±1.3cm，超声表现为实性（25/27，92.6%）或几乎完全实性（2/27，7.4%）、低回声（17/27，63%）和极低回声（10/27，37%）、不规则/分叶状边缘伴甲状腺外延伸（27/27，100%）、高宽比（13/27，48.1%）、点状回声灶（6/27，22.2%）、高血管性（23/27，85.2%）和累及颈部淋巴结（13/26，50.0%）。两种 TIRADS 均将 27 个 SCCT 评估为高度恶性风险分层（≥TR4 和 4B），并推荐 FNA 的比例为 96.3%-100%（26/27，27/27）。病理上，超过一半的 PSCCT（7/12，58.3%）和四分之一的 SSCCT（4/15，26.7%）为低分化，而中分化和高分化在 5 例 PSCCT 和 11 例 SSCCT 中观察到（P=0.007）。13 例患者（50.0%）接受了手术治疗，其中 5 例（5/13，38.5%）为根治性手术。
SCCT 是一种极其罕见且侵袭性的恶性肿瘤，以男性为主。PSCCT 和 SSCCT 的临床和超声特征相似，但肿瘤分化和声音嘶哑症状除外。SCCT 在 ACR-TIRADS 和 C-TIRADS 中显示出高度恶性风险分层，FNA 推荐率较高。
