甲状腺乳头状癌的超声特征与对侧腺叶合并隐匿癌的关系探讨  

Prediction of occult carcinoma in contralateral nodules based on the ultrasonic features of unilateral papillary thyroid carcinoma

作　　者：杨黎明[1] 李强[1] 赵博文[1] 吕江红[1] 徐海珊[1] 许立龙[1] 李世岩[1] 高力[2] 朱江[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院超声科,杭州310016 [2]浙江大学医学院附属邵逸夫医院头颈外科,杭州310016

出　　处：《中华耳鼻咽喉头颈外科杂志》2017年第4期259-262,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金（81471664）

摘　　要：目的探讨单侧甲状腺乳头状癌的超声特征与对侧腺叶隐匿癌发生的关系。方法回顾性分析2014年6月至2015年12月浙江大学医学院附属邵逸夫医院经超声或超声引导下细针穿刺细胞学检查诊断为单侧甲状腺乳头状癌合并对侧良性结节的202例患者的227个病灶的术前超声声像图，根据手术病理分为对侧隐匿癌阳性组60例和对侧隐匿癌阴性组142例，采用单因素和多因素分析甲状腺乳头状癌的声像图特征与对侧隐匿癌发生的关系。结果单因素分析显示对侧腺叶隐匿癌的发生与同侧癌灶合并桥本甲状腺炎（χ2＝3.955，P＝0.047）、边界不清（χ2＝4.375，P＝0.036）及多灶癌（χ2＝7.375，P＝0.007）有关，而与同侧癌结节的最大径、位置、A/T、形态、内部结构、内部回声、声晕、钙化、是否与包膜接触及血供程度等因素均无相关性。多因素Logistic回归分析显示同侧癌灶边界不清（OR＝2.727，P＝0.010）与多灶癌（OR＝2.807，P＝0.005）是对侧腺体隐匿癌发生的独立危险因素。结论同侧甲状腺乳头状癌边界不清和多灶癌与对侧腺体甲状腺隐匿癌的发生相关，有助于临床制定个体化的诊疗方案。Objective To investigate the occurrence of occult carcinoma in contralateral lobes based on the ultrasonic features of unilateral papillary thyroid carcinoma. Methods The study included 202 consecutives cases of unilateral papillary thyroid carcinoma with benign nodules in the contralateral lobe identified by preoperative ultrasound or fine-needle aspiration from June 2014 to December 2015. All patients received total thyroidectomies, and with postoperative pathological examination they were divided into two groups, one including 60 cases with positive occult cancer and another one consisting of 142 cases with negative occult cancer. Univariate and muhivariate analyses were performed to analyze the sonographic features of unilateral papillary thyroid carcinoma relevant to the occurrence of occult carcinoma in the contralateral nodules. Results Univariate analysis indicated occult carcinoma in the contralateral lobes was associated with Hashimoto＇s thyroiditis（ X2 = 3. 955, P = 0. 047 ）, unclear border （ X2 = 4. 375, P = 0. 036 ） and muhifocality in the ipsilateral （ X2 = 7. 375, P = 0. 007 ）, but not with tumors maximum size, location, A/T, shape, internal structure, internal echo, acoustic halo, calcification, capsular invasion and blood flow signal in the lobe with carcinoma on another side. Multivariate analysis showed unclear border （ OR = 2. 727, P = 0. 010 ） and muhifoeality in the ipsilateral （ OR = 2. 807, P = 0. 005 ） of carcinoma were independent predictive factor for eontralateral occult PTC. Conclusions Unclear border and multifocality of PTC in the ipsilateral were closely relevant to the occurrence of occuh carcinoma in the contralateral nodules.

关 键 词：超声检查 甲状腺肿瘤 癌 乳头状 危险因素 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]