CAJ | 학술논문

目的：探讨甲状腺滤泡型乳头状癌（FVPTC）的超声表现及其与病理改变的关系。方法回顾性分析38例经手术和病理证实的FVPTC 患者的超声表现，并进行病理对照研究。结果38例FVPTC的超声表现可分为3种类型：（1）Ⅰ型8例（21%），具备甲状腺乳头状癌的典型超声表现，结节形态不规则，边界不清，内部可呈极低回声，可见微小钙化；（2）Ⅱ型15例（39.5%），表现为边界较清晰的等回声或低回声结节，其形态不规则，边缘可见成角或分叶，微小钙化较少见；（3）Ⅲ型15例（39.5%），声像图表现形似腺瘤，结节边界清晰且边缘光整，内部为均匀中等回声。结合38例FVPTC的超声表现，其镜下结构特征也可相应分为3类：（1）Ⅰ型8例，病灶无明显包膜，形态不规则，呈浸润性生长；（2）Ⅱ型15例，病灶有包膜，形态不规则，病灶对包膜侵犯明显，局部突破包膜，周边可见卫星病灶；（3）Ⅲ型15例，病灶有较为完整的包膜，形态规则，病灶对包膜无明显侵犯或累及程度和范围很小。依据病灶有无包膜情况，病理诊断Ⅰ型为非包膜内型FVPTC（8/38，21%），Ⅱ、Ⅲ型为包膜内型FVPTC（30/38，79%），以上两者的形态、边界、声晕、纵横比、内部回声、微小钙化等超声特征的显示率不同，差异有统计学意义（P＜0.05），而肿瘤大小、淋巴结累及等超声特征，差异没有统计学意义（P＞0.05）。结论 FVPTC 的超声表现兼具滤泡性肿瘤和普通乳头状癌的特点，其超声表现的不同与其病理亚型密切相关。
목적：탐토갑상선려포형유두상암（FVPTC）적초성표현급기여병리개변적관계。방법회고성분석38례경수술화병리증실적FVPTC 환자적초성표현，병진행병리대조연구。결과38례FVPTC적초성표현가분위3충류형：（1）Ⅰ형8례（21%），구비갑상선유두상암적전형초성표현，결절형태불규칙，변계불청，내부가정겁저회성，가견미소개화；（2）Ⅱ형15례（39.5%），표현위변계교청석적등회성혹저회성결절，기형태불규칙，변연가견성각혹분협，미소개화교소견；（3）Ⅲ형15례（39.5%），성상도표현형사선류，결절변계청석차변연광정，내부위균균중등회성。결합38례FVPTC적초성표현，기경하결구특정야가상응분위3류：（1）Ⅰ형8례，병조무명현포막，형태불규칙，정침윤성생장；（2）Ⅱ형15례，병조유포막，형태불규칙，병조대포막침범명현，국부돌파포막，주변가견위성병조；（3）Ⅲ형15례，병조유교위완정적포막，형태규칙，병조대포막무명현침범혹루급정도화범위흔소。의거병조유무포막정황，병리진단Ⅰ형위비포막내형FVPTC（8/38，21%），Ⅱ、Ⅲ형위포막내형FVPTC（30/38，79%），이상량자적형태、변계、성훈、종횡비、내부회성、미소개화등초성특정적현시솔불동，차이유통계학의의（P＜0.05），이종류대소、림파결루급등초성특정，차이몰유통계학의의（P＞0.05）。결론 FVPTC 적초성표현겸구려포성종류화보통유두상암적특점，기초성표현적불동여기병리아형밀절상관。
Objective To investigate the pathological basis of imaging and the ultrasonic appearances of follicular variant of papillary thyroid carcinoma(FVPTC). Methods Ultrasonic appearances of 38 patients with FVPTC confirmed by surgery and pathology were analyzed retrospectively and compared with their pathological features. Results Ultrasonic appearances of 38 cases of FVPTC could be classified into three types:(1) type I 8 cases (21%), which with typical sonographic features of papillary thyroid carcinoma:nodules with irregular shape, unclear boundary, and very low echo inside, microcalcification could be seen; (2) typeⅡ15 cases (39.5%), ultrasonic performance:clearer iso-echoic or hypo-echoic nodules which have irregular shape, angled and lobular edge, but rarely microcalcification; (3) type Ⅲ 15 cases (39.5%), ultrasonic performance: they look like thyroid adenoma, and the nodule of them with clear boundary and regular edge, uniform medium echo inside. With the reference of untrasonic appearances of FVPTC, their microscopic structure characteristics could accordingly be divided into three categories:type I 8 cases, the lesions with no obvious capsule were infiltrative and irregular;typeⅡ15 cases, the lesions were enveloped and irregular, which often invaded the capsule with partial protrusion and peripheral small satellite lesions;typeⅢ15 cases, the lesions had a more complete envelope, and they were more regular with no significant or lower level and smaller extent invasion of the capsule. Based on the condition of whether the lesion had envelope, the pathological diagnosis of the lesions showed that typeⅠwas unencapsulated FVPTC (8/38, 21%), while typeⅡ and Ⅲ were encapsulated FVPTC (30/38, 79%), both of the above show difference in displaying rate of ultrasound characteristics, such as shape, boundary, acoustic halo, aspect ratio, internal echo, and microcalcifications, and the difference was statistically significant (P<0.05), whereas the difference in the tumor size and lymph node metastasis was not statistically significant (P>0.05). Conclusions Ultrasonic appearances of FVPTC show characteristics of both follicular tumor and papillary carcinoma, and the differences of ultrasonic appearances are closely related to its pathological subtypes.