樊文文 刘利平 张炎晶 王潇婧 刘静静

[摘要]目的 探讨不同大小甲状腺乳头状癌的常规超声及超声造影特征。方法 回顾性分析我院2016年1月～2017年9月经手术病理证实的197例（239个）甲状腺乳头状癌的超声表现，依据结节大小分为甲状腺微小乳头状癌（PTMC组）与>1 cm的乳头状癌（非PTMC组），对比研究两组的常规超声与超声造影特征。结果 PTMC组128个，非PTMC组111个。PTMC组纵横比（A/T）>1较非PTMC组明显多（64.8% vs. 15.3%），微钙化较非PTMC组少（61.7% vs. 82.9%），差异有统计学意义（均P<0.05）；PTMC组超声造影不均匀增强、向心性增强较非PTMC组少（59.4% vs. 79.3%，37.5% vs. 51.4%），差異有统计学意义（均P<0.05）。两组在回声、边缘、增强程度方面差异均无统计学意义（均P>0.05）。结论 不同大小甲状腺乳头状癌超声特征有所差异。A/T>1在微小癌中明显多见，对PTMC有更好的诊断价值。随着癌结节的增大，较大癌结节微钙化、超声造影不均匀增强、向心性增强更多见。

[关键词]甲状腺乳头状癌；甲状腺微小乳头状癌；常规超声；超声造影

[中图分类号] R736.1 [文献标识码] A [文章编号] 1674-4721（2018）5（a）-0004-04

[Abstract]Objective To investigate the characteristics of the conventional ultrasound and contrast-enhanced ultrasound （CEUS） in papillary thyroid carcinoma of different sizes.Methods The ultrasonographic features of 197 cases （239 nodules） of papillary thyroid carcinoma which were confirmed by surgical pathology in our hospital from January 2016 to September 2017 were analyzed retrospectively.These papillary thyroid carcinomas were divided into papillary thyroid micro-carcinoma （PTMC） and papillary thyroid carcinoma （non-PTMC） which size greater than 1 cm according to the nodule′s size，and the conventional ultrasound and the CEUS characteristics of them were comparatively studied.Results There were 128 cases of PTMC and 111 cases of non-PTMC.The A/T>1 in PTMC group was more obvious than that in non-PTMC group （64.8% vs. 15.3%），the micro-calcification in PTMC were less than that in non-PTMC（61.7% vs. 82.9%），which showed significant difference between the two groups （all P<0.05）.Compared with non-PTMC，heterogeneous enhancement and centripetal enhancement of PTMC was less （59.4% vs. 79.3%，37.5% vs. 51.4%），and significant difference were founded （all P<0.05）.No significant difference were founded in echo，margin and the enhancement intensity between two groups （all P>0.05）.Conclusion In different sizes′papillary thyroid carcinoma，the ultrasonographic characteristics are different.The A/T>1 is much more common in micro-carcinoma，which is helpful for detecting PTMC.With the size greater，the incidence of micro-calcification，heterogeneous enhancement and centripetal enhancement is much more.

[Key words]Papillary thyroid carcinoma；Papillary thyroid micro-carcinoma；Conventional ultrasound；Contrast-enhanced ultrasound

近年来，甲状腺乳头状癌（papillary thyroid carcinoma，PTC）发病趋势呈全球化激增，其中甲状腺微小乳头状癌（papillary thyroid microcarcinoma，PTMC）占比较重且增速最快[1-3]。1988年世界卫生组织（WHO）将肿瘤最大直径≤10 mm的甲状腺癌定义为微小癌[4]。前期研究认为PTC发生颈部淋巴结转移与癌结节的大小有关，既然不同大小PTC侵袭性有所差异，那么其超声特征是否也有所不同。本研究通过对239个PTC结节的常规超声及超声造影进行回顾性分析，主要对比研究微小乳头状癌与>1 cm的乳头状癌的超声特征，旨在为临床超声诊断提供依据。

1资料与方法

1.1一般资料

回顾性分析2016年1月～2017年9月就诊于我院、经手术病理证实的197例（239个结节）PTC患者，其中男43例，女154例；年龄21～71岁，平均（45.1±10.6）岁；结节最大径0.31～5.34 cm，平均（1.20±0.84）cm。本研究……