甲状腺滤泡状癌的超声及临床病理特征分析

doi:10.3877/cma.j.issn.2095-655X.2023.04.004

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1578 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨甲状腺滤泡状癌（FTC）的超声及临床病理学特征。方法选择2019年6月15日至2022年12月31日于南京市高淳人医院超声科诊断的17例FTC患者，总结其超声、组织病理以及细针穿刺细胞学(FNAC)检查术后基因检测结果的特征。结果17例患者病灶长径为（31.23±15.44）mm。超声检查示所有患者肿块回声不均匀，均无微小钙化灶；76.47%（13/17）患者的超声学特点表现为肿块最大径大于25mm，88.24%（15/17）的患者肿块可见血流信号，且其中70.59%（12/17）患者肿块内血流信号稀疏，82.35%（14/17）的患者肿块未见周围声晕；患者病灶弹性成像评分为（2.53±0.76）分。组织病理学结果显示所有病例的肿块都侵犯到了包膜及包膜外；免疫组织化学染色结果表明所有病例均为甲状腺转录因子1（TTF）阳性，降钙素阴性。9例患者进行FNAC后基因突变检测，鼠类肉瘤病毒癌基因（BRAF)突变检测均为阴性，其中6例患者进行端粒酶逆转录酶（TERT）基因突变检测，有5例为阳性。结论术后病理学检查仍然是诊断FTC的金标准，FNAC术联合分子标志物TERT的检测有助于提高FTC的术前诊断率。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：甲状腺滤泡状癌, 超声检查, 诊断, 病理学, 细针穿刺术

Abstract：ObjectiveTo investigate the ultrasonographic and clinicopathological features of follicular thyroid cancer (FTC). MethodsSeventeen patients diagnosed with FTC in the Ultrasonography Department of Nanjing Gaochun people′s Hospital between June 15, 2019 and December 31, 2022 were included to summarize the characteristics of ultrasonography, histopathology and gene testing results after fine needle aspiration cytology (FNAC) examination. ResultsThe lesions in 17 patients had an average length diameter of (31.23±15.44)mm. Uneven echo and no microcalcification were visible on ultrasound. The maximum diameter of the mass exceeded than 25 mm in 76.47% (13/17) of the patients, 88.24% (15/17) of the patients could see the blood signal in the mass, 70.59% (12/17) of the patients had sparse blood signal, and 82.35% (14/17) of the patients had no surrounding sound halo. The patients received a focal elastic imaging score of (2.53±0.76) points. Histopathological findings revealed that the mass had invaded the capsule and extended outside of the capsule in each case. Immunohistochemical analysis showed that all instances were positive for thyroid transcription factor 1 (TTF) and negative for calcitonin. Nine individuals had the post FNAC gene mutation detection, while the B-Raf proto-oncogene serine/threonine kinase (BRAF) mutation was negative. In these patients, 6 patients had telomerase reverse transcriptase (TERT) gene mutation detection, of which 5 were positive. ConclusionsPostoperative pathological examination is considered the gold standard for the diagnosis of FTC. However, the combination of FNAC and TERT detection can enhance the preoperative diagnostic accuracy of FTC.

Key words： Follicular carcinoma of thyroid Ultrasonography Diagnosis Pathology Fine-needle aspiration

收稿日期: 2022-12-31

基金资助:江苏大学2021年临床医学科技发展基金项目（JLY2021173）

通讯作者: 诸玮， Email: cszd1004@163.com

引用本文:

努尔波勒1马平2诸玮1. 甲状腺滤泡状癌的超声及临床病理特征分析[J]. 中华诊断学电子杂志, 2023, 11(4): 233-238.
Nuerbole1, Ma Ping2, Zhu Wei1.. Ultrasonographic and clinicopathological features in patients with follicular thyroid cancer. zhzdx, 2023, 11(4): 233-238.

链接本文:

http://www.zhzdxzz.com/CN/10.3877/cma.j.issn.2095-655X.2023.04.004 或 http://www.zhzdxzz.com/CN/Y2023/V11/I4/233

［1］Qiu H,Cao S,Xu R.Cancer incidence,mortality,and burden in China:a time-trend analysis and comparison with the United States and United Kingdom based on the global epidemiological data released in 2020［J］.Cancer Commun (Lond),2021,41(10):1037-1048.DOI:10.1002/cac2.12197. ［2］Kitahara CM,Sosa JA.The changing incidence of thyroid cancer［J］.Nat Rev Endocrinol,2016,12(11):646-653.DOI:10.1038/nrendo.2016.110. ［3］Hoang JK,Lee WK,Lee M,et al.US Features of thyroid malignancy:pearls and pitfalls［J］.Radiographics,2007,27(3):847-865.DOI:10.1148/rg.273065038. ［4］Scoazec JY, Couvelard A, Réseau TENpath. Classification of pancreatic neuroendocrine tumours:changes made in the 2017 WHO classification of tumours of endocrine organs and perspectives for the future［J］.Ann Pathol,2017,37(6):444-456.DOI:10.1016/j.annpat.2017.10.003. ［5］Grani G,Lamartina L,Durante C,et al.Follicular thyroid cancer and Hürthle cell carcinoma:challenges in diagnosis,treatment,and clinical management［J］.Lancet Diabetes Endocrinol,2018,6(6):500-514.DOI:10.1016/S2213-8587(17)30325-X. ［6］Itoh A,Ueno E,Tohno E,et al.Breast disease:clinical application of US elastography for diagnosis［J］.Radiology,2006,239(2):341-350.DOI:10.1148/radiol.2391041676. ［7］Zhou J,Yin L,Wei X,et al.2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules:the C-TIRADS［J］.Endocrine,2020,70(2):256-279.DOI:10.1007/s12020-020-02441-y. ［8］Durante C,Grani G,Lamartina L,et al.The diagnosis and management of thyroid nodules:a review［J］.JAMA,2018,319(9):914-924.DOI:10.1001/jama.2018.0898. ［9］Choi SH,Kim EK,Kim SJ,et al.Thyroid ultrasonography:pitfalls and techniques［J］.Korean J Radiol,2014,15(2):267-276.DOI:10.3348/kjr.2014.15.2.267. ［10］Lin Y,Lai S,Wang P,et al.Performance of current ultrasound-based malignancy risk stratification systems for thyroid nodules in patients with follicular neoplasms［J］.Eur Radiol,2022,32(6):3617-3630.DOI:10.1007/s00330-021-08450-3. ［11］Jin M,Kim ES,Kim BH,et al.Clinical implication of world health organization classification in patients with follicular thyroid carcinoma in south korea:a multicenter cohort study［J］.Endocrinol Metab (Seoul),2020,35(3):618-627.DOI:10.3803/EnM.2020.742. ［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］Daniels GH.Follicular thyroid carcinoma:a perspective［J］.Thyroid,2018,28(10):1229-1242.DOI:10.1089/thy.2018.0306. ［14］黄美,吕国荣,苏毅明,等.滤泡性甲状腺癌超声误诊分析［J］.中国超声医学杂志,2019,35(10):865-868.DOI:10.3969/j.issn.1002-0101.2019.10.001. ［15］Sillery JC,Reading CC,Charboneau JW,et al.Thyroid follicular carcinoma:sonographic features of 50 cases［J］.AJR Am J Roentgenol,2010,194(1):44-54.DOI:10.2214/AJR.09.3195. ［16］周树钧.甲状腺滤泡状癌的超声、临床病理特征及预后分析［D］ .福州：福建医科大学，2015. ［17］Hahn SY,Shin JH,Ko EY,et al.Complementary role of elastography using carotid artery pulsation in the ultrasonographic assessment of thyroid nodules:a prospective study［J］.Korean J Radiol,2018,19(5):992-999.DOI:10.3348/kjr.2018.19.5.992. ［18］Borowczyk M, Wolin＇ski K, Wickowska B, et al. Sonographic features differentiating follicular thyroid cancer from follicular adenoma-a meta-analysis［J］.Cancers (Basel),2021,13(5):938.DOI:10.3390/cancers13050938. ［19］Nikiforov YE.Molecular diagnostics of thyroid tumors［J］.Arch Pathol Lab Med,2011,135(5):569-577.DOI:10.5858/2010-0664-RAIR.1. ［20］Kakarmath S,Heller HT,Alexander CA,et al.Clinical,sonographic,and pathological characteristics of RAS-positive versus BRAF-positive thyroid carcinoma［J］.J Clin Endocrinol Metab,2016,101(12):4938-4944.DOI:10.1210/jc.2016-2620. ［21］段焕利.甲状腺肿瘤基因变异及其与临床病理特征、预后相关性的研究［D］.北京：协和医学院,2019. ［22］Pennelli G,Vianello F,Barollo S,et al.BRAF(K601E) mutation in a patient with a follicular thyroid carcinoma［J］.Thyroid,2011,21(12):1393-1396.DOI:10.1089/thy.2011.0120. ［23］Kim TH,Kim YE,Ahn S,et al.TERT promoter mutations and long-term survival in patients with thyroid cancer［J］.Endocr Relat Cancer,2016,23(10):813-823.DOI:10.1530/ERC-16-0219. ［24］Proietti A,Sartori C,Macerola E,et al.Low frequency of TERT promoter mutations in a series of well-differentiated follicular-patterned thyroid neoplasms［J］.Virchows Arch,2017,471(6):769-773.DOI:10.1007/s00428-017-2236-6. ［25］Park H,Shin H C,Yang H,et al.Molecular classification of follicular thyroid carcinoma based on TERT promoter mutations［J］.Mod Pathol,2022,35(2):186-192.DOI:10.1038/s41379-021-00907-6. ［26］沙春艳.CK19，PCNA，VEGF，TTF-1在甲状腺滤泡性肿瘤中的表达及其意义［D］.长春：吉林大学,2008.