目的

探讨甲状腺乳头状癌（PTC）超声影像与病理测值的差异性，并讨论其相关影响因素。

方法

选取2023 年1 月至12 月在绍兴市上虞人民医院甲状腺外科行甲状腺部分或全部切除的患者，病理证实为单侧叶单发的PTC。采集病灶的超声影像、大体标本、显微镜下的大小，包括左右径和上下径。采用Kruskal-Wallis H 检验比较3 种测量方式下癌灶大小的差异，对镜下病理测量结果与超声测量结果差异的影响因素行Logistic 多因素回归分析，采用χ² 检验分别比较筛选出的影响因素的发生情况。

结果

虽然3 种测量方式病灶大小整体差异没有统计学意义（P＞0.05），但显微镜下测值较超声偏大者有21 个（30.0%，21/69），显微镜下病灶测量范围大于超声影像的差值介于：0.2 ～2.2 mm（左右径）、0.1 ～0.9 mm（上下径）之间。Logistic 多因素回归分析显示，病灶内钙化及病灶周边高回声声晕是镜下病理范围偏大的保护因素（β=-2.662，P=0.039；β=-2.883，P=0.015）。镜下病理测值偏大的病灶，其内钙化和周边高回声声晕的比例更高（15/21 vs 19/48，χ²=5.927，P=0.015；11/18 vs 8/51，χ²=9.581，P=0.001）。

结论

PTC 部分病例的病理测值范围大于超声，提示病灶的主瘤体周边存在超声影像无法显示的微小癌灶；超声影像若显示微钙化或高回声声晕，超声影像测值有可能小于镜下病理测值。

Objective

To explore the differences between ultrasound imaging and pathological measurements of papillary thyroid carcinoma (PTC), and to discuss the related influencing factors.

Methods

Patients who underwent partial or total thyroidectomy in the Department of Thyroid Surgery of Shangyu People’s Hospital of Shaoxing from January 2023 to December 2023 were selected, and their pathology confirmed that they had single-occurrence papillary thyroid carcinoma (PTC) in a single thyroid lobe.The sizes of cancer lesions on ultrasonic images, on gross specimens, and under the microscope were collected.The Kruskal-Wallis H test was used to compare the differences in the sizes of the cancerous lesions measured by the three measurement methods.Logistic multivariate regression analysis was performed on the influencing factors of the differences between the pathological measurement results under the microscope and the ultrasonic measurement results.The chi-square test was used to compare the selected influencing factors,respectively.

Results

There was no significant difference among the three measurement methods as a whole of the sizes of the cancerous lesions (P＞0.05), but there were still 21 cases (30.0%, 21/69) that showed larger values under microscopy.The differences between microscopic lesion measurements and ultrasound imaging ranged as follows: transverse diameter 0.2-2.2 mm and longitudinal diameter 0.1-0.9 mm.Logistic multiple regression analysis showed that calcification within the lesion and hyperechoic halos around the lesion were protective factors for a larger pathological range on microscopic examination (β=-2.662, P=0.039;β=-2.883, P=0.015).The chi-square test revealed that lesions with high pathological values had a higher probability of internal calcification and peripheral hyperechoic halos (15/21 vs 19/48, χ²=5.927, P=0.015;11/18 vs 8/51, χ²=9.581, P=0.001).

Conclusion

The pathological extent exceeded ultrasonographic measurements in some PTC cases, suggesting that there are small cancerous lesions around the main tumor body that cannot be displayed by ultrasound imaging.If ultrasound imaging shows microcalcifications or hyperechoic halos, the ultrasound measurement may be smaller than the pathological measurement.