摘要
目的探讨超声积极监测(active surveillance,AS)甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)增长的价值。方法回顾性收集2014年1月至2018年12月期间在四川大学华西医院进行超声引导下细针穿刺活检经病理学检查确诊为PTMC且超声检查未发现颈部淋巴结转移超声征象而行AS的患者196例。按结节最大径的变化分为最大径增大组、最大径稳定组和最大径减小组,按结节体积的变化分为体积增大组、体积稳定组和体积减小组,分析各组患者的临床及超声影像特征,包括患者性别、年龄、是否合并桥本甲状腺炎、随访时间及PTMC结节大小、边界、形态、回声、纵横比、是否伴钙化灶、是否多灶性、是否累及双侧叶、是否伴有其他结节、周围组织情况、颈部淋巴结情况等,以明确肿瘤增长的相关因素。结果196例患者行AS的时间为6~79个月、其中位数(上下四分位数)时间为16.0(10.0,30.0)个月;其中117例(59.7%)患者行AS的时间为6~63个月、其中位数(上下四分位数)时间为13.0(8.0,22.0)个月,然后终止AS而行手术治疗,45例(23.0%)继续行AS,34例(17.3%)未继续于四川大学华西医院行AS。所有病例均未出现结节最大径及体积的明显减小;有9例(4.6%)结节最大径增大,187例(95.4%)结节最大径稳定;40例(20.4%)结节体积增大,156例(79.6%)结节体积稳定。结节最大径变化组间比较,患者年龄的差异有统计学意义(P<0.05);结节体积变化组间比较,患者年龄、随访时间和结节初诊时体积方面的差异均有统计学意义(P<0.05)。经logistic回归分析结果显示,年龄较小为PTMC结节体积增大的独立危险因素[OR=0.638,95%CI为(0.601,0.675),P=0.015]。结论患者年龄较小是PTMC增长的危险因素,我们应当对年龄小的患者采取更加积极的监测方案。PTMC体积的增大较其最大径的增大能更容易监测到,因此可作为AS时预测结节增长更早期的指标。
Objective To explore the value of active surveillance(AS)with ultrasound for papillary thyroid microcarcinoma(PTMC)tumor growth.Methods A retrospective collection of 196 patients who underwent ultrasound-guided fine-needle aspiration biopsy at West China Hospital of Sichuan University from January 2014 to December 2018 were pathologically diagnosed as PTMC,and no cervical lymph node metastasis was found on ultrasound,and AS was performed.According to the change of the maximum diameter of the nodule,the patients were divided into the maximum diameter increase group,the maximum diameter stable group and the maximum diameter reduction group.According to the nodule volume change,the patients were divided into the volume increase group,the volume stable group and the volume reduction group.The differences in the patients’gender,age,with Hashimoto’s thyroiditis,follow-up time,tumor size,boundary,shape,echo,aspect ratio,calcifications,multifocality,bilateral involvement,other nodule,surrounding tissues and cervical lymph nodes among the different groups were analyzed in order to clarify the related factors of tumor growth.Results One hundred and ninety-six patients had ultrasound AS time ranging from 6 to 79 months with the median(quartile)time were 16.0(10.0,30.0)months.One hundred and seventeen patients(59.7%)were in AS for 6 to 63 months with the median(quartile)time were 13.0.(8.0,22.0),surgical treatments were performed after termination of AS.Forty-five patients(23.0%)continued to perform AS,34 patients(17.3%)did not continue to perform AS in West China Hospital of Sichuan University.There was no significant reduction in the maximum diameter and volume of the nodules in all cases.Among them,9 cases(4.6%)had an increase in the maximum diameter of the nodules,and 187 cases(95.4%)had a stable maximum diameter.Forty cases(20.4%)had an increase in the volume of the nodules,and 156 cases(79.6%)had a stable volume of the nodules.Comparison of the maximum diameter change of nodules between the two groups,there was a s
作者
岳灿
胡海平
姜勇
商雷
马步云
YUE Can;HU Haiping;JIANG Yong;SHANG Lei;MA Buyun(Department of Ultrasound Medicine,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Ultrasound Medicine,Sichuan Longchang People’s Hospital,Longchang,Sichuan 642150,P.R.China;Department of Pathology,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2021年第10期1294-1300,共7页
Chinese Journal of Bases and Clinics In General Surgery
基金
四川省科技厅支持项目(项目编号:2018RZ0138)。
关键词
甲状腺微小乳头状癌
积极监测
超声
结节增长
papillary thyroid microcarcinoma
active surveillance
ultrasound
nodule growth
