ACR TI-RADS分类及血清学指标在不同大小甲状腺髓样癌风险管理中的价值

目的分析美国放射学会甲状腺影像报告与数据系统（ACR TI-RADS）分类及血清学指标在不同大小甲状腺髓样癌（MTC）风险管理中的价值。 方法回顾性纳入2010年1月至2020年6月于绍兴市人民医院就诊的经术后病理证实的MTC患者52例，共计52个甲状腺结节。所有患者术前均行甲状腺彩色多普勒超声检查以及术前血清降钙素（CT）及癌胚抗原（CEA）水平测定。依据结节大小将52个结节分为2组：＞10 mm组（大结节组）和≤10 mm组（小结节组）。分析不同大小MTC组间超声特征、TI-RADS分类、血清CT和CEA以及颈部淋巴结转移等的差异。 结果对52个MTC结节进行TI-RADS分类，46.2%（24/52）归为5类，46.2%（24/52）归为4类，5.8%（3/52）归为3类，1.9%（1/52）归为2类。52个结节中，17个为小结节组，35个为大结节组。小结节组与大结节组的结节边缘（P=0.003）、内部血流（P＜0.001）、血清CEA（P=0.001）、ACR TI-RADS评分（P=0.027）、中央区（P=0.046）及侧颈部（P=0.008）淋巴结转移差异存在统计学意义。小结节组17个结节TI-RADS分类均归为4类或5类，大结节组88.6%（31/35）归为4类或5类，但2组间TI-RADS分类比较差异无统计学意义（P=0.131）。大结节组中1例TI-RADS分类为2类，3例为3类，这4例结节大小为32.0～53.0 mm，血清学指标均有不同程度升高，血清CT的升高范围为14.5～2000 pg/ml，血清CEA的升高范围为52.3~153.9 ng/ml。 结论不同大小的MTC在超声特征、血清学指标、颈部淋巴结转移方面存在差异性。ACR TI-RADS分类在MTC的恶性风险管理中依然有效，临床可将TI-RADS分类与血清学指标相结合对MTC进行诊断评估及风险管理。

Value of ACR TI-RADS classification and serum indicators in risk management of medullary thyroid carcinoma of different sizes

ObjectiveTo assess the value of the thyroid imaging reporting and data system (TI-RADS) issued by the American College of Radiology (ACR) and serum indicators in the risk management of medullary thyroid carcinoma (MTC) of different sizes. MethodsFifty-two patients with MTC (52 thyroid nodules) confirmed by postoperative pathology at Shaoxing People's Hospital from January 2010 to June 2020 were retrospectively included. All patients underwent thyroid color Doppler ultrasound examination preoperatively. Preoperative serum calcitonin (CT) and carcinoembryonic antigen (CEA) were also measured. According to nodule size, the patients were divided into two groups: patients with nodules＞10 mm (large nodule group) and those with nodules ≤ 10 mm (small nodule group). Differences in ultrasound characteristics, serum CT and CEA, and cervical lymph node metastasis were compared between the two groups. ResultsAccording to the ACR TI-RADS classification, 46.2% (24/52) of the nodules were classified as TI-RADS 5, 46.2% (24/52) as TI-RADS 4, 5.8% (3/52) as TI-RADS 3, and 1.9% (1/52) as TI-RADS 2. Seventeen patients were included in the small nodule group and 35 patients were included in the large nodule group. The two groups had significant differences in nodule margin (P=0.003), blood flow grades (P＜0.001), serum CEA (P=0.001), and central (P=0.046) and lateral (P=0.008) cervical lymph node metastasis. Seventeen nodules in the small nodule group was classified as TI-RADS 4 or 5, and 88.6% (31/35) in the large nodule group was classified as TI-RADS 4 or 5; there was no significant difference in TI-RADS classification between the two groups (P=0.131). In the large nodule group, one case was classified as TI-RADS 2 and three cases were classified as TI-RADS 3. The size of these four nodules ranged from 32.0 to 53.0 mm. The serological indexes increased in varying degrees. The increase range of serum CT was 14.5~2000 pg/ml and the increase range of serum CEA was 52.3~153.9 ng/ml. ConclusionThere are significant differences in ultrasound characteristics, serum indicators, and cervical lymph node metastasis in different sizes of MTC . The ACR TI-RADS classification is still effective in the risk management of MTC. TI-RADS classification can be combined with serum indicators to diagnose, evaluate, and manage MTC.