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目的探讨甲状腺微小乳头状癌(PTMC)采用高分辨率超声进行检查对诊断甲状腺外侵犯的价值。方法 68例甲状腺微小乳头状癌患者,均采用高分辨率超声对甲状腺外侵犯的情况进行诊断,观察诊断结果。结果 68例患者(80个结节)经超声观察,42个结节同被膜有密切接触,其中手术病理检查对甲状腺外侵犯证实的结节26个;38个超声观察与包膜无密切接触的结节中,病理检查证实局限于甲状腺内32个,有甲状腺外侵犯6个。同被膜有密切接触的42个结节中,经病理检查证实外侵犯26个:密切接触邻近被膜共3个,无甲状腺外外侵犯;接触面积≥20%共22个,有甲状腺外外侵犯15个;接触面积≥40%共4个,有甲状腺外外侵犯2个;破坏邻近甲状腺被膜共13个,有甲状腺外外侵犯9个。PTMC与密切接触邻近被膜、接触面积≥20%、接触面积≥40%、破坏邻近甲状腺被膜的ROC曲线下面积(Az)依次为0.640、0.656、0.470、0.479。结论针对甲状腺微小乳头状癌患者,采用高分辨超声进行检查,可为甲状腺外侵犯诊断提供准确参考依据,当包膜接触面积≥20%时,更具评估甲状腺外侵犯价值。
Objective To investigate the value of high resolution ultrasound in the diagnosis of thyroid extrathyroidal invasion of thyroid papillary carcinoma (PTMC). Methods Sixty-eight patients with thyroid papillary carcinoma of small thyroid gland were diagnosed by high-resolution ultrasound in cases of extrathyroidal invasion, and the diagnostic results were observed. Results 68 patients (80 nodules) were observed by ultrasound and 42 nodules were in close contact with the capsule. Twenty-six nodules confirmed by extra-thyroid invasion were detected by surgical pathology. There was no close contact between 38 nodules and the capsule Nodules, pathological examination confirmed confined to the thyroid in 32, there are 6 extrathyroidal violations. Of the 42 nodules with close contact with the capsule, pathological examination confirmed that there were 26 extravasations invaded by the pathological examination: 3 in close contact with adjacent capsule, no extra-thyroid invasion; 22 in contact area ≥ 20% with extra-thyroid invasion 15 A; contact area ≥ 40%, a total of 4, there are two violations of thyroid outside the; destruction of the thyroid gland adjacent to a total of 13, there are 9 violations of thyroid outside. The area under the ROC curve of the adjacent thyroid gland damaged by PTMC was 0.640, 0.656, 0.470 and 0.479, respectively, with the contact area of ≥20% and the contact area of ≥40%. Conclusion For patients with thyroid papillary thyroid carcinoma, high-resolution ultrasound can provide an accurate reference for the diagnosis of extrathrebral thyroid invasion. When the contact area of the capsule is more than 20%, the value of extra-thyroid extravasation is assessed.