山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (3): 81-87.doi: 10.6040/j.issn.1673-3770.1.2020.023
马亚飞1,张岩2,商蒙蒙1,郭鲁1,孙霄1,柳腾1,李杰1
MA Yafei1, ZHANG Yan2, SHANG Mengmeng1, GUO Lu1, SUN Xiao1, LIU Teng1, LI Jie1
摘要: 目的 分析美国放射协会甲状腺影像报告及数据系统(ACR TI-RADS)4类结节分值、强回声灶类型与细针穿刺病理的关系,探讨其临床应用价值。 方法 收集TI-RADS 4类且行甲状腺细针穿刺的病例203例,将其超声评分、强回声灶类型与细针穿刺病理结果进行统计学分析。 结果 203例TI-RADS 4类结节中,不同分值结节的细针穿刺病理结果差异有统计学意义(2=46.226, P<0.001),结节分值与穿刺Bethesda分级呈正相关(r=0.470,P<0.001);4种不同类型强回声灶结节的细胞学结果差异有统计学意义(2=28.650, P<0.001),两两分析时,粗大钙化与点状强回声差异有统计学意义(2=15.742, P<0.001),与大彗星尾征差异无统计学意义(2=2.102, P=0.350);环状钙化与点状强回声及无或大彗星尾征间差异均无统计学意义(2=2.723, P=0.256;2=4.171, P=0.124)。 结论 对于TI-RADS 4类结节,进一步注意其分值及强回声灶特征,有助于结节良恶性的预测及临床决策的选择。
中图分类号:
[1] Davies L, Morris L, Hankey B. Increases in thyroid cancer incidence and mortality[J]. JAMA, 2017, 318(4): 389-390. doi:10.1001/jama.2017.7906. [2] Lim H, Devesa SS, Sosa JA, et al. Trends in thyroid cancer incidence and mortality in the United States, 1974-2013[J]. JAMA, 2017, 317(13): 1338-1348. doi:10.1001/jama.2017.2719. [3] Sanabria A, Kowalski LP, Shah JP, et al. Growing incidence of thyroid carcinoma in recent years: Factors underlying overdiagnosis[J]. Head Neck, 2018, 40(4): 855-866. doi:10.1002/hed.25029. [4] Tessler FN, Middleton WD, Grant EG, et al. Re: ACR thyroid imaging, reporting and data system(TI-RADS): white paper of the ACR TI-RADS committee[J]. J Am Coll Radiol, 2018, 15(3 Pt A): 381-382. doi:10.1016/j.jacr.2017.12.035. [5] Wesoa M, Jeleń M. Bethesda System in the evaluation of thyroid nodules: Review[J]. Adv Clin Exp Med, 2017, 26(1): 177-182. doi:10.17219/acem/27319. [6] 高晓倩, 姜震, 耿琛琛, 等. 术前超声评估分化型甲状腺癌颈部淋巴结转移[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 135-139. GAO Xiaoqian, JIANG Zhen, GENG Chenchen, et al. Preoperative ultrasonography in detecting cervical lymph node metastasis in differentiated thyroid cancer[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(1): 135-139. [7] Shin JH, Baek JH, Chung J, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean society of thyroid radiology consensus statement and recommendations[J]. Korean J Radiol, 2016, 17(3): 370-395. doi:10.3348/kjr.2016.17.3.370. [8] Park JY, Lee HJ, Jang HW, et al. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma[J]. Thyroid, 2009, 19(11): 1257-1264. doi:10.1089/thy.2008.0021. [9] Migda B, Migda M, Migda AM, et al. Evaluation of four variants of the thyroid imaging reporting and data system(TIRADS)classification in patients with multinodular goitre- initial study[J]. Endokrynol Pol, 2018, 69(2): 156-162. doi:10.5603/EP.a2018.0012. [10] Migda B, Migda M, Migda MS, et al. Use of the Kwak Thyroid Image Reporting and Data System(K-TIRADS)in differential diagnosis of thyroid nodules: systematic review and meta-analysis[J]. Eur Radiol, 2018, 28(6): 2380-2388. doi:10.1007/s00330-017-5230-0. [11] Russ G, Bonnema SJ, Erdogan MF, et al. European thyroid association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS[J]. Eur Thyroid J, 2017, 6(5): 225-237. doi:10.1159/000478927. [12] Tessler FN, Middleton WD, Grant EG. Thyroid imaging reporting and data system(TI-RADS): a user's guide[J]. Radiology, 2018, 287(1): 29-36. doi:10.1148/radiol.2017171240. [13] Lauria Pantano A, Maddaloni E, Briganti SI, et al. Differences between ATA, AACE/ACE/AME and ACR TI-RADS ultrasound classifications performance in identifying cytological high-risk thyroid nodules[J]. Eur J Endocrinol, 2018, 178(6): 595-603. doi:10.1530/EJE-18-0083. [14] Zheng Y, Xu SY, Kang HL, et al. A single-center retrospective validation study of the American college of radiology thyroid imaging reporting and data system[J]. Ultrasound Q, 2018, 34(2): 77-83. doi:10.1097/RUQ.0000000000000350. [15] Middleton WD, Teefey SA, Reading CC, et al. Comparison of performance characteristics of American college of radiology TI-RADS, Korean society of thyroid radiology TIRADS, and American thyroid association guidelines[J]. AJR Am J Roentgenol, 2018, 210(5): 1148-1154. doi:10.2214/AJR.17.18822. [16] Ha SM, Chung YJ, Ahn HS, et al. Echogenic foci in thyroid nodules: diagnostic performance with combination of TIRADS and echogenic foci[J]. BMC Med Imaging, 2019, 19(1): 28. doi:10.1186/s12880-019-0328-2. [17] Erdem Toslak I, Martin B, Barkan GA, et al. Patterns of sonographically detectable echogenic foci in pediatric thyroid carcinoma with corresponding histopathology: an observational study[J]. AJNR Am J Neuroradiol, 2018, 39(1): 156-161. doi:10.3174/ajnr.A5419. [18] Xu SY, Zhan WW, Wang WH. Evaluation of thyroid nodules by a scoring and categorizing method based on sonographic features[J]. J Ultrasound Med, 2015, 34(12): 2179-2185. doi:10.7863/ultra.14.11041. [19] Zhang J, Liu BJ, Xu HX, et al. Prospective validation of an ultrasound-based thyroid imaging reporting and data system(TI-RADS)on 3980 thyroid nodules[J]. Int J Clin Exp Med, 2015, 8(4): 5911-5917. [20] Oh EM, Chung YS, Song WJ, et al. The pattern and significance of the calcifications of papillary thyroid microcarcinoma presented in preoperative neck ultrasonography[J]. Ann Surg Treat Res, 2014, 86(3): 115-121. doi:10.4174/astr.2014.86.3.115. [21] Lacout A, Chevenet C, Thariat J, et al. Thyroid calcifications: a pictorial essay[J]. J Clin Ultrasound. 2016 May; 44(4): 245-251. doi: 10.1002/jcu.22345. [22] 李泉水, 徐细洁, 熊华花, 等. 超声显示甲状腺不同类型钙化鉴别良恶性结节的价值[J]. 中国超声医学杂志, 2017, 33(1): 11-14. LI Quanshui, XU Xijie, XIONG Huahua, et al. The value of different types of ultrasonographic calcifications in differentiating benign and malignant thyroid nodules[J]. Chinese Journal of Ultrasound in Medicine, 2017, 33(1): 11-14. [23] Malhi HS, Velez E, Kazmierski B, et al. Peripheral Thyroid Nodule Calcifications on Sonography: Evaluation of Malignant Potential[J].AJR Am J Roentgenol. 2019 Sep;213(3):672-675. doi: 10.2214/AJR.18.20799. [24] Park YJ, Kim JA, Son EJ, et al. Thyroid nodules with macrocalcification: sonographic findings predictive of malignancy[J]. Yonsei Med J, 2014, 55(2): 339-344. doi:10.3349/ymj.2014.55.2.339. [25] 华翠萍, 王建伟, 郭智兴, 等. 超声在甲状腺结节合并环状钙化的良恶性诊断中的应用[J]. 中华医学超声杂志(电子版), 2017, 14(10): 755-759. HUA Cuiping, WANG Jianwei, GUO Zhixing, et al. Ultrasonography in the diagnosis of benign and malignant thyroid nodules with rim calcification[J]. Chinese Journal of Medical Ultrasound(Electronic Edition), 2017, 14(10): 755-759. [26] Sahli ZT, Karipineni F, Hang JF, et al. The association between the ultrasonography TIRADS classification system and surgical pathology among indeterminate thyroid nodules[J]. Surgery, 2019, 165(1): 69-74. doi:10.1016/j.surg.2018.04.094. [27] Nguyen XV, Roy Choudhury K, Tessler FN, et al. Effect of tumor size on risk of metastatic disease and survival for thyroid cancer: implications for biopsy guidelines[J]. Thyroid, 2018, 28(3): 295-300. doi:10.1089/thy.2017.0526. |
[1] | 李思瑶,包宇涵,李昕莹,孙晓菁,曹小丽. 微波消融治疗不同初始体积甲状腺实性结节的疗效研究[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 58-63. |
[2] | 孙晓菁,李昕莹,李思瑶,曹小丽,薛杰,曲妮娜,高莹. 甲状腺良性结节微波消融短期疗效及影响因素分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 60-63. |
[3] | 潘新良. 加强甲状腺结节及恶性肿瘤的规范治疗[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 1-12. |
[4] | 武欣欣,李静静,毛宁,郑桂彬,郑海涛,崔景景,贾传亮,初同朋,牟亚魁,宋西成. 基于CT影像组学诺模图预测微小甲状腺结节良恶性[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 32-39. |
[5] | 徐书杭, 李春睿, 刘超. 儿童甲状腺癌的规范化诊治[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 12-15. |
[6] | 房居高. 强化手术技能和规范诊疗是提高甲状腺癌疗效的根本[J]. 山东大学耳鼻喉眼学报, 2016, 30(2): 1-4. |
|