基于2022年WHO甲状腺肿瘤分类的乳头状甲状腺癌亚型超声表现比较

Comparison of ultrasound findings of papillary thyroid carcinoma subtypes based on the 2022 WHO classification of thyroid neoplasms

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Frontiers in Endocrinology

影响因子:4.6

分区:医学3区 / 内分泌学与代谢3区

发表日期:2024

作者: İlhan Hekimsoy, Yeşim Ertan, Gürdeniz Serin, Ahmet Kasım Karabulut, Süha Süreyya Özbek

DOI: 10.3389/fendo.2024.1434787

摘要

本研究旨在分析和比较乳头状甲状腺癌（PTC）各亚型的超声特征，以探讨超声（US）是否有助于区分不同亚型。回顾性分析包含自2013年1月至2023年5月间诊断的133名患者，诊断出142个经组织学证实的PTC病例，依据世界卫生组织最新甲状腺肿瘤分类第5版。评估并比较了美国放射学会（ACR）和欧洲甲状腺影像及报告系统（TIRADS）基础上的超声特征以及结节的组织学特征。组织学分析显示，经典型PTC占38.7%（55例），侵袭性包膜滤泡变异（IEFV）占22.5%（32例），嗜银细胞亚型占14.1%（20例），非侵入性滤泡状甲状腺肿伴乳头样核特征（NIFTP）占9.9%（14例），浸润性滤泡亚型占7.8%（11例），高细胞型占4.9%（7例），实体型占1.4%（2例），弥漫性硬化型占0.7%（1例）。显示恶性特征的超声表现（如比宽高更高、边缘不规则、回声焦点和较高的TIRADS类别）在经典型PTC和高细胞型中更为常见，符合其组织学特征。相反，IEFV-PTC和NIFTP少见这些高风险超声特征。嗜银细胞亚型的超声表现与IEFV-PTC较为重叠，但低/极低回声且结节直径较大、TIRADS评分较高的超声表现更倾向于该亚型。某些亚型的超声特征能指导鉴别诊断，包括形状、边缘、回声焦点和TIRADS类别，但单纯依靠超声图像尚无法实现明确的亚型分型。

Abstract

The present study aimed to analyze and compare sonographic features of papillary thyroid carcinoma (PTC) subtypes to determine whether ultrasound (US) may aid in differentiating particular subtypes.This retrospective study enrolled 133 patients diagnosed with 142 histopathologically proven PTCs as per the fifth edition of the World Health Organization classification of thyroid neoplasms between January 2013 and May 2023. US features based on the American College of Radiology and European Thyroid Imaging and Reporting Data Systems (TIRADS), and histopathological characteristics of nodules were assessed and compared.Histopathological analysis yielded 55 (38.7%) classic PTC, 32 (22.5%) invasive encapsulated follicular variant (IEFV) PTC, 20 (14.1%) oncocytic subtype, 14 (9.9%) non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), 11 (7.8%) infiltrative follicular subtype, 7 (4.9%) tall cell subtype, 2 (1.4%) solid subtype, and 1 (0.7%) diffuse sclerosing subtype. The US findings indicating malignancy, such as taller-than-wide shape, irregular margins, echogenic foci, and higher TIRADS categories, were more frequently demonstrated in nodules with classic PTC and the tall cell subtype, in line with their histopathological features. Conversely, IEFV-PTC and NIFTP rarely exhibited these high-risk sonographic features. US appearance of the oncocytic subtype more frequently overlapped with IEFV-PTC, yet hypo/very hypoechoic nodules with larger nodular diameters and higher TIRADS scores may favor the diagnosis of this subtype.US features of certain subtypes may guide the differential diagnosis regarding shape, margin, echogenic foci, and TIRADS category of nodules; however, definitive subtyping is not yet possible using US images alone.