儿童及青少年甲状腺癌超声诊断

儿童及青少年甲状腺结节与成人相比恶性风险更高,且淋巴结转移发生率及复发率也更高。超声在儿童及青少年甲状腺癌的筛查、诊断、术前评估及术后随访中均发挥了重要作用。儿童及青少年甲状腺癌原发灶的超声特征包括实性、极低回声、微钙化、垂直位生长、边缘不规则或边界不清、甲状腺外侵犯、结节内血流增加,其肿块发现时通常较大,微钙化发生率较高,垂直位生长出现较少。根据甲状腺成像报告和数据系统可对甲状腺结节进行风险分层,指导临床决策。典型的转移性淋巴结超声包括淋巴结肿大、形态趋圆,淋巴门结构消失、皮质增厚,淋巴结内出现微钙化、囊性变或局部高回声,淋巴结内血流信号异常增多。细针穿刺细胞学检查（FNA）可鉴别可疑甲状腺结节和淋巴结的良恶性,基因检测、FNA-甲状腺球蛋白测定可进一步提高其诊断效能。儿童及青少年甲状腺癌术后需定期随访超声,这对术后甲状腺癌复发和颈部淋巴结异常的检出非常重要,可疑病灶可行FNA以明确诊断。总之,颈部超声成像及超声引导下FNA是儿童及青少年甲状腺癌诊断中非常重要的手段,在术前评估及术后随访中应作为首选的诊断方法。     

细针穿刺抽吸活检在甲状腺结节评估中的应用及进展

甲状腺结节是最常见的甲状腺异常,一般人群中,超声检出率为20％～76％,其中大部分为良性,但仍有5％～15％的甲状腺结节为恶性,即甲状腺癌,因此甲状腺结节评估的要点是良恶性鉴别,细针穿刺抽吸活检（Fine-needle aspiration biopsy,FNAB）是术前鉴别结节性质的首选方法.但FNAB仍然有自身缺陷,既包括技术层面也包括方法本身的局限性.近年FNAB联合分子诊断及免疫细胞学技术成为开发方向,以提高诊断准确性,期望为治疗、预后和随访提供依据.     

甲状腺结节诊断方法合理选择及评价

甲状腺结节是甲状腺疾病常见的症状和体征。甲状腺结节的诊断需结合病史、体格检查、实验室及辅助检查等综合考虑,并依据学科诊疗指南及临床实践经验进行规范化处理。一旦确定存在甲状腺结节后应对甲状腺功能进行评估,同时结合影像学检查结果对甲状腺结节的良恶性和病因进行初步判定,对可疑为恶性的甲状腺结节可进行细针穿刺细胞学检查或手术活检并根据病理学结果进行相应的处理。     

超声引导下细针穿刺细胞学检查术前评估甲状腺结节

目的探讨超声引导下细针穿刺细胞学检查(UG-FNAB)术前评估甲状腺结节良恶性的价值。方法对870例患者共1 024个常规超声筛选高度可疑恶性的甲状腺结节行UG-FNAB,并与手术病理进行对照研究。结果 1 024个可疑甲状腺恶性结节中,UG-FNAB检查结果阳性结节902个,阴性结节122个。手术病理结果示恶性结节918个,良性结节106个。UG-FNAB诊断结果与手术病理学诊断结果的差异无统计学意义(χ~2=1.263,P=0.261)。UG-FNAB诊断甲状腺结节的敏感度为97.71%(897/918)、特异度为95.28%(101/106)、阳性预测值为99.45%(897/902)、阴性预测值为82.79%(101/122)、准确率为97.46%(998/1 024)。870例UG-FNAB后均未发生严重并发症。结论 UG-FNAB对于术前评估甲状腺结节良恶性具有较高的应用价值。     

超声引导下甲状腺结节细针穿刺活检进展

<正>近30年,甲状腺细针穿刺活检(fine-needle aspiration biopsy,FNAB)已成为术前鉴别诊断甲状腺结节良恶性最准确和性价比较高的方法[1-4],可用于筛选适宜手术的病人,有利于降低良性结节的手术率。随着其临床应用的开展,手术切除结节的恶性所占比例已50%[5],与其应用前相比有了显著的提升。对于有经验的医生,甲状腺疾病FNAB平均诊断敏感度约为83%,波动于65%~98%,特异     

甲状腺微小癌的超声诊断

超声已经成为临床上评估甲状腺结节的首选影像学检查,超声不仅可以评估甲状腺结节的性质,还可评估颈部淋巴结的状况,是术前评估甲状腺微小癌及颈部淋巴结状况最重要的影像学检查方法。     

超声诊断良恶性甲状腺结节的进展

超声检查作为诊断甲状腺结节的首选影像学方法,可快速定位,评估结节大小、形态、内部结构、回声水平及周围淋巴结情况等。弹性成像及CEUS等超声新技术可分别评估甲状腺结节的硬度及血供情况,协助诊断结节性质。本文对超声诊断甲状腺良恶性结节的现状及进展进行综述。     

BRAF~(V600E)基因突变在FNAB易漏诊的高危甲状腺结节中的诊断价值

目的探讨BRAF~(V600E)基因突变检测在细针穿刺活检(FNAB)易漏诊的高危甲状腺结节中的诊断价值。方法回顾性收集河北中石油中心医院于2017年1月至2018年12月期间收治的术前进行超声检查及FNAB检测的甲状腺结节病例122例,所有患者的FNAB结果为非阳性细胞学结果且具有超声高危特征,对比联合FNAB和BRAF~(V600E)基因突变检测与单独FNAB检测的术后病理符合率。结果 BRAF~(V600E)基因的突变率为27.0%(33/122)。BRAF~(V600E)基因突变阳性率随着超声甲状腺影像报告和数据系统(TI-RADS)分级的增高而增高(P0.05),而与患者年龄、性别、结节数目、结节直径及FNAB结果均无关(P0.05)。FNAB联合BRAF~(V600E)基因突变检测的符合率[86.9%(106/122)比69.7%(85/122)]高于单独FNAB检测(P0.05)。结论 BRAF~(V600E)基因突变检测可发现FNAB可能漏诊的甲状腺乳头状癌,建议对高危甲状腺结节行FNAB联合BRAF~(V600E)基因突变检测。     

BRAF基因突变辅助甲状腺结节诊断为甲状腺乳头状癌的价值研究进展

目的总结BRAF基因突变辅助甲状腺结节诊断为甲状腺乳头状癌(PTC)的价值研究进展。方法收集近年来国内外有关BRAF基因突变及其联合细针穿刺细胞学检查(FNAC)诊断甲状腺良恶性结节、PTC的相关文献并作综述。结果 BRAF基因突变是PTC遗传分子中最常见的基因突变类型,BRAF基因检测联合FNAC可以提高甲状腺良恶性结节特别是PTC诊断的准确性,但BRAF基因突变检测阴性也并不能排除PTC的可能,BRAF基因突变检测对鉴别甲状腺结节良恶性仍存在一定的争议。结论 BRAF基因突变检测在不同类别的甲状腺结节中诊断价值不同,在其突变发生率较高类别的甲状腺结节(可疑的恶性肿瘤、意义不明确的细胞非典型性病变或滤泡性病变结节)中具有较高的诊断价值,而在突变发生率极低类别的甲状腺结节中很大程度上会出现假阴性,尽管如此,BRAF基因检测还是有望成为提高PTC诊断率的高特异性诊断分子标志物。     

甲状腺单发结节的诊断及手术方式

目的:探讨甲状腺单发结节中恶性结节的发生率。方法:回顾性分析经手术治疗的甲状腺单发结节352例患者的临床资料。结果:甲状腺单发结节好发于年龄20～50岁中青年女性，男性恶性结节的比率比女性高（P＜0.05）；大于50岁和小于20岁的男性甲状腺单发结节恶性发生率明显增高（P＜0.01）；触诊结节质地硬结节恶性比率高（P＜0.01）；B超能区分甲状腺单发结节的囊实性，对甲状腺良性结节的诊断符合率94.2%，恶性结节符合率66.7%；CT查对甲状腺恶性结节诊断符合率为87.5%，对甲状腺癌的包膜外侵，颈部淋巴结是否肿大有鉴别意义。穿刺细胞学诊断的符合率为81.3%，术中快速病理切片检查诊断符合率达95.8%。结论:性别、年龄、结节的质地，尤其是50岁以上和20岁以下的男性为甲状腺单发结节的恶性危险因素。B超检查可作为术前常规检查；CT检查对怀疑甲状腺恶性结节有较高的诊断价值；而穿刺细胞学检查可作为术前怀疑恶性结节的定性诊断。对甲状腺单发结节无论良、恶性均应行患侧腺叶切除。     

Suspicious thyroid nodules 4 cm require a diagnostic lobectomy regardless of their benign fine needle aspiration results

Background/objectiveThe diagnostic accuracy of fine needle aspiration biopsy (FNAB) seems limited in large thyroid nodules with Bethesda Cat. 2 result. We aimed to determine the incidence of carcinoma with benign cytology and the reason for the high false-positive rate in thyroid nodules ≥4 cm.MethodsThe records of 103 patients with thyroid nodules ≥4 cm with preoperative cytological diagnosis of Bethesda Cat. 2 who underwent thyroidectomy were consecutively reviewed. Characteristics between patients with malignant vs. benign pathology were compared.ResultsForty patients (38.8%) had malignancy. Malignancy was subclassified into follicular variant of papillary thyroid carcinoma (43%), minimally invasive follicular thyroid carcinoma (20.0%), and minimally invasive Hurthle cell thyroid carcinoma (10.9%). Patients with malignant cytology had significantly more suspicious ultrasound findings than those with benign cytology (p = 0.001).ConclusionsPreoperative FNAB showed high false-negative rates in patients with thyroid nodules ≥4 cm with benign cytology. These nodules have a high malignancy rate with suspicious ultrasound findings.     

Thyroid Nodules (≥4 cm): Can Ultrasound and Cytology Reliably Exclude Cancer?

Background

Whether a threshold nodule size should prompt diagnostic thyroidectomy remains controversial. We examined a consecutive series of patients who all had thyroidectomy for a ≥4 cm nodule to determine (1) the incidence of thyroid cancer (TC) and (2) if malignant nodules could accurately be diagnosed preoperatively by ultrasound (US), fine needle aspiration biopsy (FNAB) cytology and molecular testing.

Methods

As a prospective management strategy, 361 patients with 382 nodules ≥4 cm by preoperative US had thyroidectomy from 1/07 to 3/12.

Results

The incidence of a clinically significant TC within the ≥4 cm nodule was 22 % (83/382 nodules). The presence of suspicious US features did not discriminate malignant from benign nodules. Moreover, in 86 nodules ≥4 cm with no suspicious US features, the risk of TC within the nodule was 20 %. US-guided FNAB was performed for 290 nodules, and the risk of malignancy increased stepwise from 10.4 % for cytologically benign nodules, 29.6 % for cytologically indeterminate nodules and 100 % for malignant FNAB results. Molecular testing was positive in 9.3 % (10/107) of tested FNAB specimens, and all ten were histologic TC.

Conclusions

In a large consecutive series in which all ≥4 cm nodules had histology and were systematically evaluated by preoperative US and US-guided FNAB, the incidence of TC within the nodule was 22 %. The false negative rate of benign cytology was 10.4 %, and the absence of suspicious US features did not reliably exclude malignancy. At minimum, thyroid lobectomy should be strongly considered for all nodules ≥4 cm.     

Role of fine-needle aspiration biopsy and frozen-section evaluation in the surgical management of thyroid nodules

BACKGROUND: The role of routine frozen section (FS) in the surgical management of thyroid nodules remains uncertain. This study reviewed the role of FS in the presence of an adequate fine-needle aspiration biopsy (FNAB). METHODS: FNAB and FS were evaluated in 206 patients who had surgery for a thyroid nodule. Cytological specimens were classified as benign, malignant or suspicious. The FS diagnoses were benign, malignant or deferred. RESULTS: A cytological diagnosis was obtained in 93 nodules; the remaining 113 were classified as suspicious, of which 21 were malignant on definitive examination. The overall accuracy of FNAB was 53 per cent. FS evaluation identified 165 lesions as benign; the diagnosis was deferred until definitive histological evaluation in only eight. The overall accuracy, therefore, was 96 per cent. Routine use of FS was cost-effective; lowering the number of reoperations led to an estimated saving of about 40 per cent. CONCLUSION: These data suggest that FS remains an important tool in the surgical management of thyroid nodules and can reduce the number of patients requiring reoperation.     

Cytological and Ultrasound Findings in Indeterminate Lesions of the Thyroid Gland

Objectives

Thyroid nodules are common, and the majority are discovered incidentally on physical examination or imaging studies. Certain features on ultrasound (US) have been traditionally associated with malignant lesions and others with benign lesions. The aim of this study was to investigate the efficacy of US in determining malignancy in thyroid lesions diagnosed as indeterminate or malignant according to the cytological findings on fine needle aspiration biopsy (FNAB).

Methods

The records of 270 patients, referred to a single clinic with multinodular goiter were evaluated retrospectively, and 400 thyroid nodules sized larger than 5 mm in diameter were selected for the study. After exclusion of nodules classified as benign according to the FNAB findings, 203 thyroid nodules were included in this study. The nodules were divided into two groups on the basis of the FNAB findings: group 1 consisted of 82 nodules with indeterminate cytology and group 2 consisted of 121 nodules with cytological findings of malignancy or suspicious for malignancy.

Results

The diagnostic accuracy of ill-defined borders was 69.5% in group 1 (indeterminate) and 56% in group 2 (p=0.04). The diagnostic accuracy of solid composition was 50% in group 1 and 73% in group 2 (p=0.01). Positive correlation was demonstrated between ill-defined margins and malignant histology in group 1 (r=0.411, p=0.001), and between microcalcifications and malignant histology in group 2 (r=0.247, p=0.002).

Conclusions

In this study, the only US finding shown to be correlated with malignant histology in thyroid nodules of indeterminate cytology on FNAB was ill-defined margins. More precise US criteria are needed to decide on surgery in patients with thyroid nodules of indeterminate cytology.

     

超声造影结合粗针活检诊断甲状腺结节的临床应用价值

【摘要】 目的 探讨超声造影结合粗针活检诊断甲状腺结节的临床应用价值。方法 回顾超声造影结合超声引导下粗针活检(core-needle biopsy, CNB)诊断甲状腺结节81例患者共89个结节的超声检查资料和粗针活检病理资料,最后与手术病理结果对照分析。结果 超声造影诊断甲状腺良恶性结节的敏感性为86.7%、特异性为95.8%、准确性为91.0%。超声引导下粗针活检取材成功率100%,与手术病理结果符合率98.9%。结论 超声造影技术诊断甲状腺结节具有较高的临床价值,结合应用超声引导下粗针穿刺活检可全面准确、安全、简便的诊断甲状腺疾病,值得在临床加以推广应用。     

Selection of patients with solitary thyroid nodules for operation.

OBJECTIVE: To improve the preoperative selection for operation of patients with solitary thyroid nodules. DESIGN: Prospective cohort study. SETTING: University hospital, France. PATIENTS: 155 consecutive patients who presented with solitary thyroid nodules and were operated on. INTERVENTIONS: Clinical examination, ultrasound examination, fine needle aspiration biopsy, followed by total thyroid lobectomy with frozen section and final histological examination. MAIN OUTCOME MEASURE: Correct prediction of thyroid carcinoma or benign adenoma. RESULTS: A logistic regression analysis indicated that absence of rim (p < 0.002), solid and hypoechoic feature (p < 0.003) and malignant or suspicious fine needle aspiration biopsy results (p < 0.0001) were significantly associated with malignancy. Selection for operation by the logistic model would save 40 of 73 patients from operation and 40 of 59 from unnecessarily radical operation. It would detect a similar number of cancers as a strategy based solely on fine needle aspiration cytology. CONCLUSIONS: A combination of the available diagnostic methods provides substantial benefit in the preoperative selection of patients with an isolated thyroid nodule.     

Pediatric adaptions are needed to improve the diagnostic accuracy of thyroid ultrasound using TI-RADS

Background/PurposeThyroid Imaging Reporting and Data System (TI-RADS) is validated in adults but not yet in children. The purpose of this study was to determine the sensitivity, specificity, and accuracy of TI-RADS in predicting thyroid malignancy for pediatric nodules, and to compare the diagnostic accuracy to the current American Thyroid Association (ATA) guidelines.MethodsA single institution retrospective review was performed of patients younger than 21 years who underwent thyroid nodule fine needle aspiration biopsy (FNAB). Two radiologists were blinded to the pathology and independently classified all biopsied thyroid nodules based on TI-RADS. ATA and TI-RADS guidelines were analyzed to determine the diagnostic sensitivity and specificity of both scoring systems.Results115 patients (median age 15.5 years, 90 females) with 138 nodules were scored using TI-RADS. There was moderate inter-rater agreement between radiologists (Kappa = 0.51; p < 0.0001). Evaluating several potential TI-RADS criteria, 23.2%-68.1% of nodules were recommended for FNAB, compared to 82.6% of nodules using ATA guidelines. Using TI-RADS ≥ 3 (without size cutoff) as an indication for FNAB had 100% sensitivity with no missed suspicious or malignant nodules on cytology or pathology.ConclusionsUsing TI-RADS for diagnostic management of pediatric thyroid nodules improves accuracy in predicting malignancy.     

CD147 检测对细针穿刺细胞学可疑恶性的甲状腺结节的诊断价值

目的：探讨CD147检测在细针穿刺活检未能明确细胞学诊断的甲状腺结节中的临床应用价值。 方法：选择2013年10月—12月收治的甲状腺结节患者，对术后手术标本进行细针穿刺涂片，用Bethesda甲状腺细胞学报告系统评价腺细胞病理学，选择36例“可疑恶性肿瘤”标本行免疫组化CD147染色分析。CD147阳性者作恶性诊断，结果与手术后石蜡病理结果比较。 结果：CD147检测诊断良性病变19例（52.78%），恶性病变17例（47.22%），术后病理检查诊断良性病变16例（44.44%），恶性病变20例（55.56%）；甲状腺恶性标本中CD147的阳性表达率明显高于良性标本（P<0.05）。CD147的表达与甲状腺结节是否钙化（CD147阳性率89.47%）及淋巴转移（CD147阳性率100%）有关（P<0.05）。细针穿刺细胞学联合CD147免疫组化染色鉴别甲状腺结节良、恶性的准确性和敏感度分别为91.67%和85.0%。 结论：CD147可以作为甲状腺肿瘤细胞学诊断分子生物学标志物，细针穿刺细胞学联合CD147免疫组化分析，有助于提高甲状腺癌的术前检出率。     

超声引导下粗针穿刺活检在甲状腺疾病诊断中的应用

[摘要] 目的 探讨超声引导下粗针穿刺活检(ultrasound-guided Core-needle biopsy ,US-CNB) 在甲状腺疾病诊断中的应用。方法 对2004年5月～2013年3月在我院手术的146例甲状腺疾病患者共计152个甲状腺结节术前进行超声引导下粗针穿刺活检,将穿刺病理与手术病理结果进行对照,并分析其超声图像特点。结果 152个粗针穿刺病理报告中,恶性92个,术后病检证实其中90例确诊为甲状腺癌,2例为良性病变;甲状腺良性病变56个 ,术后病检其中2例为甲状腺癌;未明确诊断者4个,术后病检3例为良性,1例为甲状腺癌,USCNB对直径>0.7cm的结节穿刺确诊率较高,甲状腺粗针穿刺活检的敏感度、特异度、准确率分别为：96.7%、91.5%、94.7%。结论 USCNB对甲状腺疾病确诊率因结节直径大小不同而有差异,超声引导下甲状腺粗针穿刺活检操作简单,定位准确,创伤小,并发症少,准确性高,是非手术条件下取得病检的首选方法。