分化型甲状腺癌超声钙化形态学类型与肿瘤生物学特性及其变异的相关性研究  

Correlation studies of ultrasonic morphological types and the biological variation in calcification of the differentiated thyroid cancer

作　　者：张毅[1] 袁梅[1] 周亚丽[1] 房世保[1] Zhang Yi;Yuan Mei;Zhou Yali;Fang Shibao(Department of Ultrasound in Health Management Center,the Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院健康管理中心超声科,26600

出　　处：《中华超声影像学杂志》2019年第9期776-781,共6页Chinese Journal of Ultrasonography

摘　　要：目的探讨分化型甲状腺癌(DTC)的超声钙化形态学类型与肿瘤生物学特性及其变异的相关性与临床诊断价值。方法回顾性分析经超声、手术和临床病理学诊断的598例DTC钙化患者的临床资料。参照2017版美国放射学院(ACR)甲状腺影像报告与数据系统(TI-RADS)标准,根据DTC超声钙化形态学特点分为5种类型,应用Spearman法分析DTC超声钙化形态学类型与肿瘤生物学特性及其变异的相关性。结果598例患者中经典型甲状腺乳头状癌(PTC)527例(88.13%);经典型甲状腺滤泡状癌(FTC)27例(4.52%);DTC变异型44例(7.36%),包括滤泡型25例,高细胞型9例,透明细胞型6例和嗜酸细胞型4例。TI-RADSⅠ~Ⅲ类44例(7.36%),细针穿刺抽吸细胞学检查(FNAC)Ⅳ类179例(29.93%),Ⅴ类375例(62.71%)。超声与临床病理学诊断符合率为92.64%(554/598)。554例DTC超声钙化形态学类型:Ⅰ型微钙化416例(75.09%),Ⅱ型钙化71例(12.82%),Ⅲ型钙化41例(7.40%),Ⅳ型钙化20例(3.61%),Ⅴ型钙化6例(1.08%)。Ⅰ型、Ⅱ型和Ⅲ型超声钙化形态学类型与DTC肿瘤生物学特性及其变异亚型之间存在相关性(r=0.634,0.592,0.479;均P=0.01)。结论TI-RADSⅣ~Ⅴ类+Ⅱ~Ⅲ级Adler彩色血流信号对超声诊断DTC具有较高实用价值,对Ⅳ类可疑DTC者可行FNAC检查。Ⅰ~Ⅲ型超声钙化形态学类型为DTC肿瘤生物学特性及其变异的主要类型,对超声诊断DTC具有重要临床价值,为指导FNAC、选择手术方式、术后随访和预后判断提供重要参考依据。Objective To explore the correlation between ultrasound features and tumor biological variation with calcification morphological types in differentiated thyroid carcinoma (DTC). Methods The clinical data of 598 patients with DTC calcification diagnosed by ultrasound, surgery and clinicopathology were retrospectively analyzed. According to the 2017 edition of the American College of Radiology (ACR) Thyroid Imaging Report and Data System (TI-RADS) classification system standard, DTC ultrasonic calcification morphological characteristics were divided into 5 types, and the correlation between DTC ultrasonic calcification morphological types and tumor biological characteristics and their variations were analyzed by Spearman correlation analysis. Results Of the 598 patients, 527 cases (88.13%) were typical papillary thyroid cancer(PTC), 27 cases (4.52%) were typical follicular thyroid cancer(FTC), and 44 cases (7.36%) were variant subtype (including 25 cases of follicular type, 9 cases of high cell type, 6 cases of clear cell type and 4 cases of eosinophilic type). TI-RADS diagnosis: 44 cases (7.36%) were Ⅰ~Ⅲ class, 179 cases (29.93%) were Ⅳ class performing fine needle aspiration cytology(FNAC), 375 cases (62.71%) were Ⅴ class. The coincidence rate between ultrasound and clinicopathological diagnosis was 92.64%(554/598). Morphological types of ultrasonic calcification in 554 cases of DTC: type Ⅰ microcalcification in 416 cases (75.09%);type Ⅱ calcification in 71 cases (12.82%);type Ⅲ calcification in 41 cases (7.40%);type Ⅳ calcification in 20 cases (3.61%);type Ⅴ calcification in 6 cases (1.08%). There were correlations between type Ⅰ,Ⅱ,Ⅲ ultrasonic calcification morphological types and the tumor biological characteristics and its variant subtypes of DTC(r=0.634, 0.592, 0.479;all P=0.01). Conclusions TI-RADS Ⅳ-Ⅴ class level+ Adler Ⅱ-Ⅲ blood flow has a high practical value for the ultrasonic diagnosis of DTC, and FNAC can be performed in suspicious type Ⅳ DTC. Type Ⅰ-Ⅲ ultrasonic

关 键 词：超声检查 甲状腺癌 分化型 钙化类型 肿瘤生物学 

分 类 号：R736.1[医药卫生—肿瘤]