■本研究旨在探讨原发性甲状腺鳞状细胞癌(PSCCT)和继发性SCCT(SSCCT)的临床超声特征,并评估细针穿刺(FNA)推荐SCCT的准确性与美国放射学学会甲状腺成像和报告数据系统(ACR-TIRADS)和中国TIRADS(C-TIRADS)。
■我们检索了26例SCCT患者(11例PSCCT,15SSCCT)来自我们医院的病理数据库(5,718例甲状腺恶性肿瘤患者),超过23年。回顾性分析26例27例SCCT患者的病历及超声资料,每个SCCT病灶根据两个TIRADS进行分类。
■对于26名患者(21名男性,5名女性),年龄范围为42-81岁,快速扩大的甲状腺/颈部结节(18/26,69.2%),吞咽困难(7/26,26.9%),声音嘶哑(6/26,23.1%),呼吸困难(5/26,19.6%),咳嗽(4/26,15.4%),颈部疼痛(2/26,7.7%),B症状(2/26,7.7%),和痰中的血液(1/26,3.8%)在诊断时出现。超声检查发现5例无症状患者(5/26,19.2%)。声音嘶哑在PSCCT中(5/11,45.5%)比SSCCT中(1/15,6.7%)更常见(P=0.032)。对于平均尺寸为3.7±1.3cm的27个SCCT,超声特征由固体(25/27,92.6%)或几乎完全固体组成(2/27,7.4%)组成,低回声(17/27,63%)和极低回声回声(10/27,37%),不规则/分叶状边缘伴甲状腺外延伸(27/27,100%),高的比宽的形状(13/27,48.1%),点状回声灶(6/27,22.2%),高血管(23/27,85.2%)和累及颈部淋巴(13/26,50.0%)。两个TIRADS共评估了27个SCCT为高恶性危险分层(≥TR4和4B),推荐的FNA为96.3-100%(26/27,27/27)。病理上,超过一半的PSCCT(7/12,58.3%)和四分之一的SSCCT(4/15,26.7%)分化差,而在5个PSCCT和11个SSCCT中观察到中度和高度分化的等级(P=0.007)。13例(50.0%)患者行根治性手术5例(5/13,38.5%)。
■SCCT是一种极其罕见且侵袭性的恶性肿瘤,以男性为主。PSCCT和SSCCT具有相似的临床和超声特征,除了肿瘤分化和声音嘶哑症状。SCCT在ACR-TIRADS和C-TIRADS中显示出高恶性危险分层,具有较高的FNA推荐率。
UNASSIGNED: This study aimed to investigate the clinico-ultrasound features of primary squamous cell carcinoma of the thyroid (PSCCT) and secondary SCCT (SSCCT) and evaluate the accuracy of fine needle aspiration (FNA) recommendation for SCCT with American College of Radiology-Thyroid Imaging and Reporting Data System (ACR-TIRADS) and Chinese-TIRADS (C-TIRADS).
UNASSIGNED: We retrieved 26 SCCT patients (11 PSCCT, 15 SSCCT) from our hospital\'s pathology database (5,718 patients with thyroid malignancy) over 23 years. Medical records and ultrasound data of the 26 patients with 27 SCCTs were analyzed retrospectively, and each SCCT focus was categorized based on the two TIRADSs.
UNASSIGNED: For 26 patients (21 males, 5 females) with an age range of 42-81 years, rapidly enlarging thyroid/neck nodules (18/26, 69.2%), dysphagia (7/26, 26.9%), hoarseness (6/26, 23.1%), dyspnea (5/26, 19.6%), cough (4/26, 15.4%), neck pain (2/26, 7.7%), B symptoms (2/26, 7.7%), and blood in sputum (1/26, 3.8%) were presented at diagnosis. Five asymptomatic patients (5/26, 19.2%) were detected by ultrasound. Hoarseness was more common in PSCCT (5/11, 45.5%) than in SSCCT (1/15, 6.7%) (P=0.032). For 27 SCCTs with a mean size of 3.7 ± 1.3 cm, the ultrasound features consisted of solid (25/27, 92.6%) or almost completely solid composition (2/27, 7.4%), hypoechoic (17/27, 63%) and very hypoechoic echogenicity (10/27, 37%), irregular/lobulated margin with extra-thyroidal extension (27/27, 100%), taller-than-wide shape (13/27, 48.1%), punctate echogenic foci (6/27, 22.2%), hypervascularity (23/27, 85.2%) and involved neck lymph (13/26, 50.0%). A total of 27 SCCTs were evaluated as high malignancy risk stratification (≥TR4 and 4B) by the two TIRADSs and recommended FNA in 96.3-100% (26/27, 27/27). Pathologically, more than half of PSCCTs (7/12, 58.3%) and a quarter of SSCCTs (4/15, 26.7%) were poorly differentiated, while moderately and well-differentiated grades were observed in 5 PSCCTs and 11 SSCCTs (P=0.007). Thirteen patients (50.0%) underwent surgery with radical operation in 5 cases (5/13, 38.5%).
UNASSIGNED: SCCT is an extremely rare and aggressive malignancy with a male predominance. PSCCT and SSCCT had similar clinical and ultrasound features except for tumor differentiation and the symptom of hoarseness. SCCT showed a high malignancy risk stratification in ACR-TIRADS and C-TIRADS, with a high rate of FNA recommendation.