甲状腺乳头状癌ACRTI-RADS分类及其转移和伴发疾病分析

何学森 余小琴 钟晓

[摘要] 目的 綜合分析甲状腺乳头状癌ACR TI-RADS分类及其伴发疾病、转移情况特征，以提高超声诊断人员利用ACR TI-RADS分类对甲状腺乳头状癌与其他疾病的认识，能更好地鉴别及检出甲状腺乳头状癌。 方法 基于ACR TI-RADS分类回顾分析首次手术并证实甲状腺乳头状癌163例，综合分析瘤体超声特征、伴发疾病、转移情况。结果 甲状腺乳头状癌发病率男：女=1：3.79;淋巴结转移男性64.70%（22/34）高于女性48.06%（62/129）;癌体以实性结节占96.9%（158/163）;癌体回声以低和极低回声占69.9%;直立性生长的占比73.0%; 边缘光滑/模糊及不能确定的占比19.0%。出现点状强回声的癌灶占比47.2%，局灶性强回声≥3分的结节占70.6%;≥7分（TI-RADS 5类）癌灶占比86.5%，发生淋巴结转移患者的TI-RADS评分12.00（10.00，14.00）高于未发生转移的患者[11.00（8.00，13.00）（P=0.003）]。病灶单发占73.6%（120/163），病灶数≥2个的占26.4%（43/163）;单侧癌灶占81.6%（133/163），双侧癌灶占18.4%（30/163）。甲状腺乳头状癌伴随结节性甲状腺肿或淋巴性甲状腺炎的发生机率占74.85%（122/163），甲状腺乳头状癌伴随疾病与否与转移无统计学意义（P>0.05）。 结论 超声诊断应用ACR TI-RADS分类结合其伴发疾病、转移情况综合分析对甲状腺乳头状癌具有较好的检出率。

[关键词] 甲状腺乳头状癌;伴发疾病;超声;ACR TI-RADS;病理学

[中图分类号] R736.1;R445.1          [文献标识码] B          [文章编号] 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.