甲状腺滤泡型乳头状癌的超声及临床特征

目的评估甲状腺滤泡型乳头状癌（FVPTC）的超声表现及临床特征。 方法回顾性分析2007年1月至2017年10月于上海交通大学医学院附属瑞金医院手术并经病理证实为FVPTC的127个结节。超声评估指标包括：最大径、边缘、纵横比、内部结构、回声水平、钙化、后方衰减、声晕、血供程度，将超声指标纳入甲状腺超声影像报告和数据系统（TI-RADS），并与经典型PTC相比较。同时分析FVPTC超声引导下细针穿刺抽吸活检结果（US-FNAB）及淋巴结转移率。采用t检验比较FVPTC和经典型PTC组结节大小的差异；采用χ²检验比较FVPTC和经典型PTC组的淋巴结转移和TI-RADS分类的差异。 结果（1）FVPTC结节大小为（23.47±12.75）mm，大于经典型PTC的大小［（10.84±6.10）mm］，差异具有统计学意义（t=10.077，P＜0.001）；大部分FVPTC结节表现为边缘规则、纵横比≤1、实性、低回声、无钙化、无后方衰减、无声晕、中等血供。TI-RADS分类在FVPTC与经典型PTC之间差异具有统计学意义（χ²=28.891，P＜0.001），在非腺瘤样FVPTC与经典型PTC之间差异无统计学意义（χ²=3.988，P=0.125）。（2）US-FNAB诊断FVPTC良性6例，滤泡性病变6例，可疑恶性及恶性15例，符合率55.56%（15/27）。（3）FVPTC淋巴结转移率低于经典型PTC（10.68% vs 29.92%；χ²=12.560，P=0.001）。 结论FVPTC的超声表现多样，淋巴结转移率低，加深认识能有效提高诊断的准确性。

Sonographic and clinical features of follicular variant papillary thyroid carcinoma

ObjectiveTo investigate the sonographic and clinical features of follicular variant papillary thyroid carcinoma (FVPTC). MethodsOne hundred and twenty-seven FVPTC nodules that were confirmed by pathology at Ruijin Hospital, Shanghai Jiaotong University from January 2007 to October 2017 were retrospectively analyzed. The sonographic features assessed included maximum diameter, margin, orientation, composition, echogenicity, calcification, posterior attenuation, halo, and vascularization. The indexes were incorporated into the thyroid ultrasound imaging report and data system (TI-RADS), and the TI-RADS classification of FVPTC was then compared with that of classic PTC. At the same time, ultrasound-guided fine-needle aspiration biopsy (US-FNAB) and lymph node metastasis of FVPTC were analyzed. The t-test was used to compare the difference in size and the χ² test was used to compare the difference in lymph node metastasis and TI-RADS classification between FVPTC and classic PTC groups. ResultsThe mean size of FVPTC nodules was (23.47±12.75) mm, which was significantly larger than that of classic PTC (10.84±6.10) mm; t=10.077, P＜0.001]. Most of FVPTCs had sonographic features of smooth margin, aspect ratio ≤1, being solid, hypoechoic echogenicity, no calcification, no posterior attenuation, no sound halo, and medium blood supply. TI-RADS classified showed that FVPTC and classic PTC were statistically different (χ²=28.891, P＜0.001), but between non-adenomas-like FVPTC and classical PTC there was no difference (χ²=3.988, P=0.125). The coincidence rate of US-FNAB with pathological diagnosis in FVPTC was 55.56% (15/27). The lymph node metastasis rate of FVPTC was lower than that of classic PTC (10.68% vs 29.92%; χ²=12.560, P=0.001). ConclusionFVPTCs have different sonograms and low lymph node metastasis rate. A deeper understanding of FVPTCs can effectively improve the accuracy of diagnosis.