何學森 余小琴 鐘曉

[摘要] 目的 綜合分析甲狀腺乳頭狀癌ACR TI-RADS分類及其伴發(fā)疾病、轉(zhuǎn)移情況特征，以提高超聲診斷人員利用ACR TI-RADS分類對甲狀腺乳頭狀癌與其他疾病的認識，能更好地鑒別及檢出甲狀腺乳頭狀癌。 方法 基于ACR TI-RADS分類回顧分析首次手術(shù)并證實甲狀腺乳頭狀癌163例，綜合分析瘤體超聲特征、伴發(fā)疾病、轉(zhuǎn)移情況。結(jié)果 甲狀腺乳頭狀癌發(fā)病率男：女=1：3.79;淋巴結(jié)轉(zhuǎn)移男性64.70%（22/34）高于女性48.06%（62/129）;癌體以實性結(jié)節(jié)占96.9%（158/163）;癌體回聲以低和極低回聲占69.9%;直立性生長的占比73.0%; 邊緣光滑/模糊及不能確定的占比19.0%。出現(xiàn)點狀強回聲的癌灶占比47.2%，局灶性強回聲≥3分的結(jié)節(jié)占70.6%;≥7分（TI-RADS 5類）癌灶占比86.5%，發(fā)生淋巴結(jié)轉(zhuǎn)移患者的TI-RADS評分12.00（10.00，14.00）高于未發(fā)生轉(zhuǎn)移的患者[11.00（8.00，13.00）（P=0.003）]。病灶單發(fā)占73.6%（120/163），病灶數(shù)≥2個的占26.4%（43/163）;單側(cè)癌灶占81.6%（133/163），雙側(cè)癌灶占18.4%（30/163）。甲狀腺乳頭狀癌伴隨結(jié)節(jié)性甲狀腺腫或淋巴性甲狀腺炎的發(fā)生機率占74.85%（122/163），甲狀腺乳頭狀癌伴隨疾病與否與轉(zhuǎn)移無統(tǒng)計學意義（P>0.05）。 結(jié)論 超聲診斷應(yīng)用ACR TI-RADS分類結(jié)合其伴發(fā)疾病、轉(zhuǎn)移情況綜合分析對甲狀腺乳頭狀癌具有較好的檢出率。

[關(guān)鍵詞] 甲狀腺乳頭狀癌;伴發(fā)疾病;超聲;ACR TI-RADS;病理學

[中圖分類號] R736.1;R445.1 ? ? ? ? ?[文獻標識碼] B ? ? ? ? ?[文章編號] 1673-9701（2019）13-0100-04

[Abstract] Objective To comprehensively analyze the classification of ACR TI-RADS in thyroid papillary carcinoma and the characteristicsits of its accompanying disease and metastasis， so as to improve the understanding of ultrasound clinicians using ACR TI-RADS classification for papillary thyroid carcinoma and other diseases， and to identify and detect thyroid papillary cancer better. Methods Based on the ACR TI-RADS classification， 163 cases of thyroid papillary carcinoma undergoing first surgery and confirmed with papillary thyroid carcinoma were retrospectively analyzed. The tumor ultrasound characteristics， accompanying disease and metastasis were comprehensively analyzed. Results The incidence of papillary thyroid carcinoma was male： female=1：3.79; lymph node metastasis in males was 64.70%（22/34）， higher than that in females（48.06%， 62/129）; solid nodules accounted for 96.9%（158/163） in cancer body; the low and very low echo of cancer body echoes accounted for 69.9%; upright growth of tumors accounted for 73.0%; tumors with smooth/blurred edges and undetermined edges accounted for 19.0%. The tumors with strong echoes in points accounted for 47.2%， the nodules with focal strong echoes ≥3 points accounted for 70.6%; the lesions with ≥7 points （TI-RADS 5） accounted for 86.5%; and the TI-RADS score of 12.00（10.00， 14.00） in patients with lymph node metastasis was higher than 11.00（8.00，13.00） of patients without metastasis（P=0.003）. The single lesions accounted for 73.6%（120/163）， the lesions ≥2 accounted for 26.4%（43/163）; the unilateral cancers accounted for 81.6%（133/163）， and the bilateral cancers accounted for 18.4%（30/163）. The incidence of papillary thyroid carcinoma associated with nodular goiter or lymphocytic thyroiditis accounted for 74.85%（122/163）， and there was no significant difference between whether the thyroid papillary carcinoma associated with disease or not and metastasis（P>0.05）. Conclusion Ultrasound diagnosis ACR TI-RADS classification combined with its accompanying disease and metastasis analysis has a good detection rate for papillary thyroid carcinoma.