超声低估甲状腺3类和4a类结节的细胞和组织病理表现  

Cellular and Histopathological Characteristics of Ultrasonically Underdiagnosed 3/4a Thyroid Nodules

作　　者：吴玮琦 许存宝 李尤佳 苏春阳 张峰顺 陈一峰[1] WU Weiqi;XU Cunbao;LI Youjia;SU Chunyang;ZHANG Fengshun;CHEN Yifeng(Department of Pathology,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou,Fujian 362000,China;Department of Ultrasound,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou,Fujian 362000,China)

机构地区：[1]福建医科大学附属泉州第一医院病理科,福建泉州362000 [2]福建医科大学附属泉州第一医院超声科,福建泉州362000

出　　处：《中国医学科学院学报》2025年第1期23-28,共6页Acta Academiae Medicinae Sinicae

基　　金：福建省自然科学基金(2023J011792)。

摘　　要：目的分析超声低估恶性风险的中国甲状腺影像报告与数据系统(C-TIRADS)3类和4a类结节的细胞和组织病理表现,以提高对此类病变的认识。方法以组织病理学为标准,收集549例甲状腺手术患者的683个结节的超声、细针穿刺细胞学检查资料,分析C-TIRADS 3类和4a类结节的细胞和组织病理特征。结果甲状腺C-TIRADS 3类结节268个,其中良性病变236个,低风险肿瘤12个,恶性结节20个(7.46%);C-TIRADS 4a类结节221个,其中良性病变133个,低风险肿瘤7个,恶性结节81个(36.65%),C-TIRADS 3类与4a类结节恶性率差异有统计学意义(χ^(2)=58.93,P<0.001),均高于C-TIRADS恶性危险分层指南推荐的恶性率(P均<0.001)。低估为C-TIRADS 3类和4a类结节的病理类型主要为甲状腺乳头状癌,特别是伴有桥本甲状腺炎者,低风险结节超声诊断结果和细胞学分类的对应关系不确定。结论当甲状腺乳头状癌(特别是合并桥本甲状腺炎)、滤泡癌及髓样癌等术前超声图像的恶性特征不典型或缺乏时,会被低估为C-TIRADS 3类或4a类结节,应提高对此类病变细胞和组织病理特征的认识。Objective To analyze the cellular and histopathological characteristics of underdiagnosed thyroid nodules of Chinese thyroid imaging reporting and data system(C-TIRADS)categories 3 and 4a,thus improving the understanding of these lesions.Methods The data of ultrasound and fine needle aspiration cytology were collected from 683 nodules diagnosed based on pathological evidence in 549 patients undergoing thyroid surgery.The cellular and histopathological characteristics of C-TIRADS 3 and 4a nodules were analyzed.Results Two hundred and sixty-eight nodules were classified as C-TIRADS category 3,including 236 benign nodules,12 low-risk ones,and 20(7.46%)malignant ones.Two hundred and twenty-one nodules were classified as C-TIRADS category 4a,including 133 benign nodules,7 low-risk ones,and 81(36.65%)malignant ones.The malignancy rates differed between C-TIRADS 3 and 4a nodules(χ^(2)=58.93,P<0.001),and both were higher than the recommended malignancy rate in the guidelines for malignancy risk stratification of thyroid nodules(C-TIRADS)(both P<0.001).According to the pathological evidence,the underdiagnosed C-TIRADS 3/4a nodules were mainly papillary thyroid carcinoma,especially in patients with Hashimoto thyroiditis.There was not a consistent one-to-one match between each ultrasound result and each cytological classification of low-risk thyroid nodules.Conclusions When the malignant features in preoprative ultrasound imaging are atypical or absent,papillary thyroid carcinoma(especially with Hashimoto thyroiditis),follicular carcinoma,and medullary carcinoma are likely to be underdiagnosed as C-TIRADS 3 or 4a nodules.Therefore,efforts should be made to fully understand the cellular and pathological characteristics of these lesions.

关 键 词：甲状腺结节 低估恶性风险 血糖 病理 中国甲状腺影像报告与数据系统 

分 类 号：R365[医药卫生—病理学]