甲状腺结节超声C-TIRADS 5征象的组织病理结构影响因素分析  

Analysis of factors affecting the histopathological structure on ultrasonic C-TIRADS 5 signs of thyroid nodules

作　　者：徐天宇 程岚卿 彭梅[3] 王弦[1,4] 秦蓉[1,4] 虞红珍[1,4] XU Tian-yu;CHENG Lan-qing;PENG Mei;WANG Xian;QIN Rong;YU Hong-zhen(Department of Pathology,the Second Affiliated Hospital of Anhui Medical University,Heifei 230601,China;Department of Pathology,the First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Hospital,Hefei 230036,China;Department of Ultrasonic Diagnosis,the Second Affiliated Hospital of Anhui Medical University,Heifei 230601,China;Department of Pathology,Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学第二附属医院病理科,合肥230601 [2]中国科学技术大学附属第一医院(安徽省立医院)病理科,合肥230036 [3]安徽医科大学第二附属医院超声科,合肥230601 [4]安徽医科大学基础医学院病理学教研室,合肥230032

出　　处：《临床与实验病理学杂志》2023年第4期433-438,共6页Chinese Journal of Clinical and Experimental Pathology

基　　金：安徽省高校自然科学研究重点项目(KJ2020A0183);安徽医科大学校科研基金(2021xkj174);安徽医科大学第二附属医院临床研究培育计划(2020LCYB14)。

摘　　要：目的从组织结构角度探讨甲状腺结节超声C-TIRADS 5征象的病理基础。方法选取不同病理诊断结果的甲状腺结节600例,分析其组织病理图像中实质与间质排列分布情况,并收集对应超声中关于结构、回声水平、边界、纵横比、点状强回声团5征象信息,应用单因素χ^(2)检验及非条件二元、多元Logistic回归分析探究超声C-TIRADS 5征象的组织病理结构影响因素。结果实性结构与囊性或囊实性结构的结节恶性率差异有显著性(P<0.05);低回声水平的组织病理影响因素包括:广泛纤维化(P<0.001,OR=8.849)、乳头结构(P<0.001,OR=8.685)、微滤泡结构(P<0.001,OR=4.199)、局灶纤维化(P<0.001,OR=2.728);边界不清的影响因素包括:广泛纤维化(P<0.001,OR=8.326)、乳头结构(P<0.001,OR=4.073)、局灶纤维化(P=0.016,OR=1.914)、炎细胞浸润(P=0.042,OR=1.743);纵横比≥1的影响因素包括:广泛纤维化(P<0.001,OR=6.765)、乳头结构(P<0.001,OR=4.515)、微滤泡结构(P=0.049,OR=1.88);点状强回声团的影响因素包括:乳头结构(P<0.001,OR=18.407)、砂粒体(P=0.031,OR=9.465)、广泛纤维化(P<0.001,OR=6.594)、粗钙化(P=0.041,OR=2.602)、局灶纤维化(P=0.011,OR=2.545)、微滤泡结构(P=0.009,OR=2.452)。C-TIRADS≥4B的恶性概率为83.3%。结论间质广泛纤维化是影响甲状腺结节C-TIRADS各征象最显著的组织病理因素,从而能解释部分伴间质广泛显著纤维化的良性结节出现C-TIRADS分类较高的现象。Purpose To investigate the pathological basis of C-TIRADS 5 signs from the perspective of tissue structure.Methods 600 cases of thyroid nodule with different pathological diagnoses were selected,the distribution of parenchymal and interstitial arrangement in histopathological images were analyzed,then the information about structure,echo level,boundary,aspect ratio and punctate echogenic foci in ultrasonic report was collected.The single factorχ^(2) analysis and unconditional binary,multiple logistic regression analysis were used to explore the factors influencing the histopathological structure of the C-TIRADS 5 signs on ultrasound.Results The malignant rate of nodules was significantly different between solid structure and cystic or cystic solid structure(P<0.05).Histopathological factors associated with hypoechoic included:extensive fibrosis(P<0.001,OR=8.849),papillary structure(P<0.001,OR=8.685),microfollicles(P<0.001,OR=4.199),focal fibrosis(P<0.001,OR=2.728).The factors of ill-defined boundary included extensive fibrosis(P<0.001,OR=8.326),papillary structure(P<0.001,OR=4.073),focal fibrosis(P=0.016,OR=1.914),inflammatory cell infiltration(P=0.042,OR=1.743).The factors of aspect ratio≥1 included extensive fibrosis(P<0.001,OR=6.765),papillary structure(P<0.001,OR=4.515),microfollicles(P=0.049,OR=1.88).The factors of punctate echogenicfoci included papillary structure(P<0.001,OR=18.407),psammoma body(P=0.031,OR=9.465),extensive fibrosis(P<0.001,OR=6.594),macrocalcification(P=0.041,OR=2.602),focal fibrosis(P=0.011,OR=2.545),microfollicles(P=0.009,OR=2.452).The malignant rate of C-TIRADS≥4B was 83.3%.Conclusion Extensive interstitial fibrosis is the most significant histopatgological factor affecting all signs of C-TIRADS in thyroid nodules,which can explain the phenomenon of high C-TIRADS grade in some benign nodules.

关 键 词：甲状腺结节 病理 超声 C-TIRADS 

分 类 号：R581[医药卫生—内分泌]