中国实用外科杂志

中国实用外科杂志

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儿童及青少年甲状腺癌超声诊断

张桂萍，詹维伟   

  1. 上海交通大学医学院附属瑞金医院超声科，上海200025
  • 出版日期:2022-06-01

  • Online:2022-06-01

摘要： 儿童及青少年甲状腺结节与成人相比恶性风险更高，且淋巴结转移发生率及复发率也更高。超声在儿童及青少年甲状腺癌的筛查、诊断、术前评估及术后随访中均发挥了重要作用。儿童及青少年甲状腺癌原发灶的超声特征包括实性、极低回声、微钙化、垂直位生长、边缘不规则或边界不清、甲状腺外侵犯、结节内血流增加，其肿块发现时通常较大，微钙化发生率较高，垂直位生长出现较少。根据甲状腺成像报告和数据系统可对甲状腺结节进行风险分层，指导临床决策。典型的转移性淋巴结超声包括淋巴结肿大、形态趋圆，淋巴门结构消失、皮质增厚，淋巴结内出现微钙化、囊性变或局部高回声，淋巴结内血流信号异常增多。细针穿刺细胞学检查（FNA）可鉴别可疑甲状腺结节和淋巴结的良恶性，基因检测、FNA-甲状腺球蛋白测定可进一步提高其诊断效能。儿童及青少年甲状腺癌术后需定期随访超声，这对术后甲状腺癌复发和颈部淋巴结异常的检出非常重要，可疑病灶可行FNA以明确诊断。总之，颈部超声成像及超声引导下FNA是儿童及青少年甲状腺癌诊断中非常重要的手段，在术前评估及术后随访中应作为首选的诊断方法。

关键词: 超声诊断, 超声引导, 细针抽吸, 儿童, 青少年, 甲状腺癌, 淋巴结转移

Abstract: Ultrasonic diagnosis of thyroid cancer in children and adolescents        ZHANG GUI-ping，ZHAN Wei-wei. Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Corresponding author：ZHAN Wei-wei，E-mail：shanghairuijin@126.com
Abstract    Compared with adults，thyroid nodules in children and adolescents have a higher risk of malignancy，and the rate of lymph node metastasis and recurrence is also higher. Ultrasound plays an important role in screening，diagnosis，preoperative evaluation and postoperative follow-up of thyroid cancer in children and adolescents. The ultrasonic features of primary thyroid cancer in children and adolescents include solid，extremely low echo，microcalcification，vertical growth，irregular/unclear edge，extrathyroid invasion，and increased blood flow in the nodules. Its volume when it is found is larger，microcalcification rate is higher，and vertical growth is less. According to the thyroid imaging reporting and data system，the risk of thyroid nodules can be layered to guide clinical decisions. Typical ultrasound of metastatic lymph nodes include enlarged lymph nodes，rounded shape，disappearance of lymphatic portal structure，thickening of cortex，microcalcification，cystic degeneration or local hyperecho in lymph nodes，and abnormal increase of blood flow signals in lymph nodes. Fine needle aspiration（FNA）cytological diagnosis can distinguish benign and malignant suspicious thyroid nodules and lymph nodes，and gene detection and FNA- thyroglobulin test can further improve the diagnostic efficiency. Regular follow-up ultrasound is required in children and adolescents after thyroid cancer surgery，which is very important for the detection of postoperative thyroid cancer recurrence and cervical lymph node abnormalities. The suspicious lesions can be confirmed by FNA. In conclusion，cervical ultrasound imaging and ultrasound-guided FNA are very important tools in the diagnosis of thyroid cancer in children and adolescents and should be the preferred diagnostic method in preoperative evaluation and postoperative follow-up.

Key words: ultrasonic diagnosis, ultrasound guidance, fine needle aspiration, children, adolescents, thyroid cancer, lymph node metastasis