甲状腺乳头状微小癌与非微小癌的超声特征

目的分析甲状腺乳头状微小癌与非微小癌的声像图特征。方法回顾性分析242例经手术病理证实的甲状腺乳头状癌患者的超声声像图特征,将其分为直径≤1cm微小癌和直径〉1cm非微小癌,对比两者在形态、纵横比、边界、回声、声晕、钙化、囊变、血流、颈部淋巴结转移及合并甲状腺疾病等方面的差异。结果242例共287个癌灶,其中39例为多灶性（39／242,16．12％）;微小癌154个,非微小癌133个。超声检出274个病灶,漏诊微小癌13个,误诊为结节性甲状腺肿或腺瘤等良性病灶42个。甲状腺乳头状微小癌与非微小癌的边界、纵横比、囊变、血流及颈部淋巴结转移率差异有统计学意义（P均〈0．05）,而在形态、钙化、声晕及合并甲状腺疾病上差异无统计学意义（P均〉0．05）。结论超声在甲状腺乳头状癌的诊断中具有重要价值;甲状腺乳头状微小癌与非微小癌的超声表现具有差异。     

甲状腺微小乳头状癌的临床诊断

目的总结甲状腺微小乳头状癌的临床诊断要点。方法回顾性分析44例甲状腺微小乳头状癌患者的临床资料。结果患者均行手术治疗并经病理证实,其中术前确诊3例,术中冰冻确诊38例,术后病理证实3例。4例合并甲状腺良性疾病,伴颈淋巴结转移2例。结论甲状腺微小乳头状癌起病隐匿,不易诊断,常规检查不易发现,多数仍在术中及术后病理检查中被发现,应综合使用高频超声检查、CT扫描、核磁共振、放射性核素显像检查、细针穿刺细胞学检查、术中快速冰冻病理检查等方法来提高甲状腺微小乳头癌的诊断率。     

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。     

超声征象对甲状腺微小乳头状癌的预测价值

目的探讨多种超声征象对甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)的预测价值。方法回顾性分析2013年1月至2016年12月浙江省杭州市第一人民医院超声科经病理证实且直径≤1 cm的396例603枚微小结节性甲状腺肿(micronodular goiter,MNG)和539例640枚PTMC的超声资料,按照不同检查时间,将所有结节分为模型组(2013~2014年)和检验组(2015~2016年),观察瘤体形态、内部回声、微钙化及纵横比(A/T),采用单因素χ^2检验和多因素Logistic回归分析4种超声征象在PTMC和MNG中的分布差异,并评估其诊断价值。结果模型组和检验组的单因素分析显示,MNG及PTMC的瘤体形态(模型组:χ^2=283.54,P=0.000;检验组:χ^2=298.119,P=0.000)、内部回声(模型组:χ^2=63.130,P=0.000;检验组:χ^2=87.400,P=0.000)、微钙化(模型组:χ^2=26.342,P=0.000;检验组:χ^2=50.152,P=0.000)及A/T(模型组:χ^2=169.918,P=0.000;检验组:χ^2=181.405,P=0.000)等超声征象差异具有统计学意义。多因素Logistic回归分析显示形态不规则、低回声、A/T>1和微钙化是PTMC的影响因素,OR值分别为18.410和19.231、2.560和6.380、9.379和6.724、3.102和8.830,模型组和检验组多种超声征象预测概率曲线下面积值分别为0.916和0.911。结论形态不规则、内部低回声、微钙化和A/T>1均是预测PTMC稳定的重要超声征象,对多种超声征象进行综合分析可提高诊断效能。     

甲状腺乳头状微小癌6例报道

甲状腺乳头状微小癌(papillary microcarcinoma，PMC)临床上诊断比较困难，大多数病例是在甲状腺手术中偶然发现或术后病理检查才发现的。我院自1996年9月至2003年12月期间收治经手术和病理证实的甲状腺乳头状微小癌6例，男1例，女5例。年龄27～55岁，平均42岁。病程2个月～10年，平均2年。单侧甲状腺肿块4例．双侧甲状腺     

甲状腺乳头状微小癌的诊断及外科治疗

甲状腺乳头状微小癌（papillary thyroid micro-carcinoma,PTMC）是甲状腺乳头状腺癌（PTC）的一个特殊亚型。1988年WHO严格界定瘤体最大直径≤1.0 cm的甲状腺癌为微小癌。甲状腺微小癌发病率占甲状腺癌的6%～35%。其中,PTMC占绝大多数[1]。     

超声引导下RFA治疗甲状腺微小乳头状癌的效果

探讨超声引导下射频消融(RFA)治疗甲状腺微小乳头状癌的临床效果。2017年1月—2018年3月,甲状腺微小乳头状癌患者187例,均给予超声引导下RFA治疗,观察随访术后肿瘤体积变化,以及手术前后应激因子、甲功水平。结果显示术后12个月病灶体积缩小率为(92.29±14.01)%,明显高于术后1个月、3个月和6个月(P<0.05);术后1周丙二醛(MDA)、超氧化物歧化酶(SOD)和肿瘤坏死因子-α(TNF-α)与术前差异无统计学意义(P>0.05);术后1个月促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)和游离甲状腺素(FT4)与术前比较差异无统计学意义(P>0.05);未发现有声音嘶哑、出血、食管及喉返神经损伤等并发症发生。结果表明,超声引导下RFA治疗甲状腺微小乳头状癌的效果较好,无明显应激反应,对甲状腺功能影响较小,安全性高。     

甲状腺微小乳头状癌的研究进展

随着术前检出率的不断增高,甲状腺微小乳头状癌(PTMC)已成为临床关注热点。笔者综述PTMC相关研究的进展及现状,主要内容包括:发病特点、临床征象、诊断方法及病理检查、治疗方法和预后。     

甲状腺球蛋白与甲状腺微小乳头状癌的相关性分析

目的探讨血液中甲状腺球蛋白(thyroglobulin,Tg)水平与甲状腺微小乳头状癌(papillary thyroid microcarcinoma, PTMC)的关系。方法回顾性分析2017年1月至2019年8月安徽医科大学第二附属医院甲状腺与乳腺外科及宿州市立医院肿瘤外科就诊手术的TI-RADS 4b类直径≤1 cm单侧甲状腺肿块的患者共539例,依据患者术后病理结果分为PTMC组和良性肿瘤组,再依据病理结果有无颈部淋巴结转移(lymph node metastasis,LNM)将PTMC患者分为LNM组和无LNM组,分析术前血液中促甲状腺素(thyroid stimulating hormone,TSH)、甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)和Tg与PTMC及发生颈部LNM的关系。应用SPSS 21.0软件进行数据的统计分析。采用独立样本t检验方法比较PTMC组与良性肿瘤组,LNM组与无LNM组间各指标的关系。结果患者年龄、TSH、Tg及TgAb水平是PTMC的独立影响因素,其中年龄与PTMC呈负相关,TSH、Tg、TgAb与PTMC呈正相关(回归系数分别为:-0.020、0.192、0.026、0.008,95%CI分别为:0.962~0.998、1.045~1.404、1.015~1.038、1.003~1.014,P<0.05)。年龄和血清Tg水平是PTMC患者颈部LNM的独立影响因素,其中年龄与颈部LNM呈负相关,Tg与颈部LNM呈正相关(回归系数分别为:-0.025、0.014,95%CI分别为:0.957~0.994、1.008~1.021,P<0.05)。当血清Tg水平>26.520 ng/ml时提示≤1 cm的TI-RADS 4b类肿块为PTMC(敏感度:0.560,特异度:0.719);而Tg水平>36.695 ng/ml时提示此类PTMC患者伴有颈部LNM(敏感度:0.532,特异度:0.788)。结论血清Tg水平对临床鉴别≤1 cm的甲状腺肿块的良恶性具有重要意义,同时其也与PTMC伴有颈部LNM有关。     

甲状腺微小乳头状癌外科治疗争议与共识

目前,临床对甲状腺微小乳头状癌（PTMC）的处理策略和外科治疗还存在一些争议。在没有“金标准”来区别惰性PTMC和进展性PTMC之前,密切观察的策略不适合我国的国情和医疗环境,不宜过度推广,对诊断明确的PTMC应手术治疗。国内外指南中关于甲状腺的切除范围基本一致,低危病人选择甲状腺腺叶+峡部切除术,中高危病人应行全或近全甲状腺切除术。主张对手术病人至少进行同侧中央区淋巴结清扫,不做预防性颈侧区淋巴结清扫。建议结合能获取的危险因素进行综合评估,并兼顾病人意愿、术者能力,平衡并发症和疾病风险,选择个体化的手术方式。     

微小乳头状甲状腺癌的腔镜手术治疗

目的探讨腔镜手术治疗微小乳头状甲状腺癌（papillary thyroid microcarcinoma,PTMC）的可行性、有效性及安全性。方法2006年3月~2008年9月,行经胸乳入路腔镜下甲状腺手术204例,术中冰冻切片检查报告PTMC 16例,在腔镜下行患侧甲状腺腺叶全切除＋对侧腺叶次全切除＋Ⅵ区淋巴结清扫术。结果16例手术时间70~160 min,平均115min。肿瘤最大径0.2~1.0 cm,平均0.56 cm。2例（12.5%）术后一过性喉返神经损伤导致暂时性声音嘶哑,术后1~2个月恢复。无术后出血、皮下气肿、饮水呛咳以及低血钙。术后病理报告均为PTMC。Ⅵ区淋巴结清扫数目2~10个,平均4.6个,其中6例（37.5%）淋巴结有癌转移。随访时间6~30个月,平均18个月,其中7例〉24个月,B超和单光子发射计算机断层扫描（ECT）提示患侧甲状腺无残留腺体,局部无复发。结论腔镜甲状腺手术治疗PTMC是安全可行的,可作为PTMC手术治疗的一种选择。     

纳米碳示踪剂在甲状腺微小乳头状癌手术中的应用

目的探讨纳米碳淋巴示踪剂在甲状腺微小乳头状癌中央区淋巴结清扫术中的应用价值。方法自2015年1月至2016年7月收治的40例单侧甲状腺微小乳头状癌患者被随机纳入对照组(20例)和纳米碳组(20例)。纳米碳组在患侧腺叶切除前给予纳米碳标记,手术均按患侧腺叶+峡部切除+患侧中央区淋巴结清扫术进行,由同一手术组医生完成。比较两组手术时间、术中出血量、术后引流液量,统计中央区淋巴结获取数目,误切甲状旁腺例数,术后低血钙发生率,喉返神经损伤率。计量资料采用(x珋±s)表示,采取t检验;术后并发症发生率采用百分率表示,结果采取χ2检验,数据分析采用SPSS 19.0软件。当P0.05时认为结果具有统计学差异。结果在手术时间、术中出血量、术后引流液量方面,两组比较差异均无统计学意义(P0.05)。纳米碳组术后中央区淋巴结获取数目显著多于对照组[(8±1.5)枚比(4±0.9)枚],P0.05;误切甲状旁腺对照组5例(25%),纳米碳0例(0)。两组均无永久性喉返神经损伤及低钙血症发生,一过性低钙血症对照组3例(15%),纳米碳组0例(0)(P0.05)。结论通过纳米碳混悬液进行术中淋巴结染色,可以显著增加中央区淋巴结清扫数目,并有助于辨认和保护甲状旁腺,降低淋巴结清扫可能带来的甲状旁腺误切除和术后低血钙发生。     

Extent of Thyroidectomy Is Not a Major Determinant of Survival in Low- or High-Risk Papillary Thyroid Cancer

Background The optimal extent of thyroidectomy for papillary thyroid cancer (PTC) is controversial. Our objective was to evaluate the effect of total thyroidectomy or partial thyroidectomy on survival in low- and high-risk patients.Methods The Surveillance, Epidemiology, and End Results database was used to identify PTC patients who underwent thyroidectomy. The independent effects of age, distant metastases, extrathyroidal extension, tumor size, sex, lymph node metastases, radioactive iodine use, and extent of thyroidectomy on survival were analyzed for low- and high-risk PTC.Results There were 4402 (81%) low-risk and 1030 (19%) high-risk patients; 84.9% underwent total thyroidectomy. The 5- and 10-year survival were 95% and 89% in the low-risk patients and 84% and 73% in the high-risk patients, respectively (P = .001). In the low-risk patients, 10-year survival after total thyroidectomy was 89%, compared with 91% after partial thyroidectomy (adjusted hazard ratio for death, 1.73; 95% confidence interval, 1.28–2.33; P < .001); older age, male sex, larger tumor, lymph node metastases, and lack of radioactive iodine were associated with higher mortality. In the high-risk patients, 10-year survival after total thyroidectomy was 72%, compared with 78% after partial thyroidectomy (adjusted hazard ratio for death, 1.46; 95% confidence interval, .89–2.40; P = .14); older age, distant metastases, larger tumors, and lack of radioactive iodine were associated with higher mortality.Conclusions Survival of patients with PTC was not significantly influenced by the extent of thyroidectomy. The survival after partial thyroidectomy was similar to total thyroidectomy within both the low- and high-risk prognostic groups.     

Lymph Node Status Influences Follow-Up Thyroglobulin Levels in Papillary Thyroid Cancer

Background  Elevated thyroglobulin (Tg) levels post surgery are associated with disease recurrence in papillary thyroid carcinoma (PTC). The aim of this study is to determine which clinicopathological factors influence Tg elevation following surgery and radio-iodine ablation (RAI) for PTC. Methods  A retrospective study of consecutive patients undergoing total thyroidectomy and RAI for PTC was carried out. Prophylactic central neck dissection (CND) was performed if the diagnosis of PTC was made preoperatively. Lateral neck dissection (LND) was guided by ultrasound findings. RAI was administered 6 weeks postoperatively. Stimulated Tg levels were measured at 12 months. Results  One hundred patients with PTC were studied. Forty patients had routine CND. The median tumour size was 15 mm. Median stimulated Tg level at 12 months was 0.3 μg/L. On multivariate analysis the number of metastatic lymph nodes removed had a significant positive association with serum Tg levels (P = 0.003). The total number of lymph nodes resected had a significant inverse relationship with serum Tg levels (P = 0.04). Tumour size, multifocality, vascular and capsular invasion did not appear to have significant correlation with Tg levels. Conclusion  Lymph node metastases are associated with increased postablative Tg levels in PTC. More complete lymphadenectomy is associated with lowering of Tg levels.     

CCR7在甲状腺乳头状微小癌中的表达及临床意义

目的探讨CCR7在甲状腺乳头状微小癌中表达情况及其与甲状腺乳头状微小癌临床病理特征的关系。方法采用免疫组织化学S-P法检测31例甲状腺乳头状微小癌,34例直径>1 cm的甲状腺乳头状癌、34例结节性甲状腺肿以及12例甲状腺乳头状微小癌对侧正常甲状腺组织中CCR7的表达情况。结果 CCR7在甲状腺乳头状微小癌及直径>1 cm甲状腺乳头状癌中的表达阳性率均为100%,其差异无统计学意义(P>0.05),而在结节性甲状腺肿和正常甲状腺组织中CCR7的表达阳性率分别为64.7%和33.3%,与甲状腺乳头状微小癌相比差异有统计学意义(P<0.05)。CCR7的表达与患者性别、年龄、侵犯甲状腺被膜及淋巴结转移均无关(P>0.05)。结论 CCR7的表达在甲状腺乳头状微小癌和直径>1 cm甲状腺乳头状癌中均呈高表达,两者可能具有相同的生物学特性,两者均易发生颈淋巴结转移,均需要进行颈淋巴结(中央区)清扫。     

Thyroid Papillary Carcinoma Recurring as Squamous Cell Carcinoma: Report of a Case

We report a case of local squamous cell carcinoma recurrence of thyroid papillary carcinoma, 4 years after subtotal thyroidectomy, in an 82-year-old woman. The papillary cancer of the right thyroid was histopathologically classified as T2a, N0, M0, Ex1; pT2a, pN1b, pEx1; Stage III. Fine-needle aspiration cytology of the recurrent tumor revealed atypical squamous epithelium-like cells with keratinization. The tumor was judged cytologically to be class III, defined as a suspicious malignancy and, after reoperation, it was diagnosed histopathologically as papillary carcinoma recurrence with extensive squamous metaplasia. The recurrent papillary carcinoma was thought to have changed to a squamous cell carcinoma because most of the tumor was occupied by atypical squamous cells, with a small amount of glandular tissue. The primary tumor was histologically diagnosed as a well-differentiated papillary carcinoma at the initial operation. It contained numerous tall neoplastic cells with eosinophilic granules and pseudostratified nuclei, indicating that it could potentially transform into squamous cell carcinoma. We report this case as an example of how squamous cell carcinoma of the thyroid can develop.     

Metastatic Papillary Thyroid Carcinoma to the Maxilla: Case Report and Literature Review

Metastatic tumors to the oral cavity are uncommon and a thyroid origin is considered exceedingly rare. A case of metastatic papillary thyroid carcinoma (PTC) presenting as a painful swelling in the right posterior maxilla of a 63-year-old male is reported here. The patient had been diagnosed with PTC 2 years ago and treated with thyroidectomy and radioactive iodine treatment. Radiographically, the metastatic lesion presented as a poorly-defined radiolucent lesion around an impacted maxillary third molar in the right maxilla. Histopathologic examination revealed features of PTC which was immunohistochemically positive for pancytokeratin, keratin 19 and thyroglobulin. Imaging studies revealed the presence of residual maxillary and neck disease as well as additional metastatic lesions in the sternum, ribs, and left tibia. A thorough review of the English language literature revealed only 36 previously published cases of thyroid cancer metastases to the oral cavity, the demographic and clinicopathologic features of which are summarized.     

甲状腺乳头状癌颈淋巴结转移途径的探讨

探讨甲状腺乳头状腺癌颈淋巴结转移途径的规律及其临床意义。方法:1991年1月～2002年5月,为97例甲状腺乳头状腺癌颈淋巴结转移的病人作了108次功能性颈淋巴结清扫术。参照美国耳鼻咽喉头颈外科基金协会颈淋巴结分区法,分析淋巴结转移的规律。结果:Ⅵ、Ⅳ、Ⅲ区淋巴结转移最为常见,转移率分别为78.5%、70.3%、68.5%;尤其在转移早期的Ⅳ和Ⅲ区转移中,转淋巴结多位于颈内静脉后方,单靠触诊不易发现;Ⅰ区较少淋巴结转移;Ⅱ、Ⅴ区淋巴结转移率居中。结论:本研究的发现有助于甲状腺乳头状腺癌手术时前哨淋巴结活检的设计,并恰当地选择清扫区域和范围。     

人甲状腺乳头状癌原代细胞的体外长期培养

目的探索人甲状腺乳头状癌原代细胞的体外长期培养方法及其监测鉴定手段。方法常规分离甲状腺乳头状癌细胞,并用含10%胎牛血清、L-谷氨酰胺和20 ng/ml人重组表皮生长因子(EGF)的高糖型DMEM培养液培养,分别在不同时间观察甲状腺乳头状癌细胞生长情况,测定培养液中的甲状腺球蛋白(Tg)和甲状腺过氧化物酶(TPO)水平,用免疫细胞化学方法检测Tg的表达。结果培养约8 d甲状腺乳头状癌细胞长满约80%的培养瓶底,符合传代标准;在培养45 d内生长良好,经5~6传代后细胞逐渐老化。细胞培养液中Tg含量随培养时间延长呈抛物线形变化,培养约14 d Tg达到峰值(985.2μg/L);TPO在细胞培养液中始终未检测到。免疫荧光染色结果显示,体外培养甲状腺乳头状癌原代细胞的Tg表达阳性。结论应用本研究建立的培养条件可以使人甲状腺乳头状癌原代细胞传5~6代,细胞存活约45 d。建立了简便、系统的监测及鉴定甲状腺乳头状癌细胞生物活性手段,提示在14 d左右该细胞用于基因研究较为合适,为研究甲状腺乳头状癌发生、发展机理及其特征提供了一种合适替代工具。