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目的描述甲状腺结节的临床、病理特点;分析甲状腺结节大小与甲状腺癌患病风险之间的关系。方法回顾性分析2008~2014年于济宁医学院附属医院行甲状腺结节切除术的3 476例患者的组织病理学诊断资料,有明确病理学资料和结节直径记载的共5 548个结节,按不同直径分为5组:<1.0cm、1.0-1.9 cm、2.0-2.9 cm、3.0-3.9 cm、≥4.0 cm,对各组结节中甲状腺癌发生率进行分析比较。结果 (1)甲状腺结节高发年龄为40-60岁,病理类型以结节性甲状腺肿为主(53.7%),因桥本病及亚急性甲状腺炎行手术治疗,属误诊病例(2.0%)。(2)3 476例甲状腺结节患者中,评价的结节共5 548个,甲状腺癌共1 482个(占26.7%),其中乳头状甲状腺癌1 425个(占甲状腺癌的96.2%)。(3)在直径<1.0 cm、1.0-1.9 cm、≥2.0 cm结节中甲状腺癌和乳头状癌的发生率存在差异(P<0.01)。(4)在直径≥2.0 cm的结节中,乳头状癌发生率随结节直径的增加呈下降趋势,直径≥4.0 cm的结节中乳头状癌的发生率显著低于直径2.0-2.9 cm的结节(P<0.05)。(5)随着肿瘤直径的增加,乳头状癌所占的比例逐渐下降,滤泡样癌与其他类型癌所占的比例呈逐渐增加的趋势(P<0.01)。结论在直径<1.0 cm、1.0-1.9 cm、≥2.0 cm结节中甲状腺癌和乳头状癌的发生率存在差异;随结节直径的增加,乳头状癌的发病风险呈降低趋势,滤泡细胞癌与其他少见甲状腺癌的发病风险呈升高趋势。
Objective To describe the clinical and pathological features of thyroid nodules and to analyze the relationship between thyroid nodule size and the risk of thyroid cancer. Methods The histopathological diagnosis data of 3 476 patients undergoing thyroidectomy at Affiliated Hospital of Jining Medical College from 2008 to 2014 were retrospectively analyzed. There were 5 548 nodules recorded by definite pathology data and nodule diameter, According to different diameters, the patients were divided into 5 groups: <1.0cm, 1.0-1.9cm, 2.0-2.9cm, 3.0-3.9cm, ≥4.0cm. The incidence of thyroid cancer in each group was analyzed and compared. Results (1) The incidence of thyroid nodules was 40-60 years. The pathological type was mainly nodular goiter (53.7%). Misdiagnosis cases (2.0%) were due to surgical treatment of Hashimoto’s and subacute thyroiditis. . (2) Among 3 476 thyroid nodules, 5 548 nodules were evaluated, 1 482 (26.7%) had thyroid cancer, and 1 425 papillary thyroid cancer (96.2% of thyroid cancer). (3) The incidence of thyroid carcinoma and papillary carcinoma in nodules of diameter <1.0 cm, 1.0-1.9 cm, and ≥2.0 cm were different (P <0.01). (4) In nodules ≥2.0 cm in diameter, the incidence of papillary carcinoma decreased with the increase of nodule diameter, and the incidence of papillary carcinoma in nodules ≥4.0 cm was significantly lower than those with diameter of 2.0-2.9 cm Of nodules (P <0.05). (5) With the increase of tumor diameter, the proportion of papillary carcinoma gradually decreased, and the proportion of follicular carcinoma and other types of carcinoma showed a gradual increase (P <0.01). Conclusions The incidence of thyroid carcinoma and papillary carcinoma in nodules of diameter <1.0 cm, 1.0-1.9 cm and ≥2.0 cm are different. With the increase of nodule diameter, the incidence of papillary carcinoma is decreasing. The incidence of follicular cells The risk of cancer and other rare thyroid cancer is on the rise.