Clinical Study Of Diagnosis And Treatment On Follicular Thyroid Tumor

Objective:To explore the ultrasonographic and clinicopathological features of thyroid follicular tumors,and to analyze the relationship between surgical methods and intraoperative rapid pathology and postoperative paraffin pathology,so as to more accurately distinguish benign and malignant thyroid follicular tumors.avoid excessive diagnostic surgery or inadequate treatment,and better guide clinical diagnosis and treatment decisions.Methods:A retrospective analysis was performed on 98 patients with preoperatively diagnosed follicular tumors from January 2017 to January2019,and they were divided into three groups A,B,and C according to the postoperative paraffin pathological results.Follicular thyroid adenoma(FTA)was diagnosed pathologically,with a total of 23 cases;group B paraffin pathology was diagnosed with Tumors of uncertain malignant potential(FT-UMP),a total of 50 cases;Group C was a total of25 patients with Follicular thyroid carcinoma(FTC)confirmed by paraffin pathology.Collate and analyze clinical data such as preoperative ultrasound imaging examination,thyroid function(mainly thyroglobulinTg level),nodule size,rapid intraoperative freezing pathology,surgical methods,and postoperative paraffin pathological results of the three groups of patients.Differences in ultrasound performance and clinicopathological characteristics.Result:1.Ultrasound performanceFTA: 22 cases with clear borders(95.7%),18 cases with uniform thickness halo(78.3%),12 cases of hyperechoic nodules(52.2%),11 cases of cystic and cystic nodules(47.8%),solid 12 cases(52.2%)had sexual nodules,14 cases(60.9%)had no blood supply to the nodules,18cases(78.3%)had halo correction,and 9 cases(39.1%)had abundant blood flow signals.FT-UMP: 20 cases with unclear borders(40%),44 cases(88%)with hypoechoic nodules,10 cases(20%)with microcalcification,28 cases with solid nodules(56%)There were 43 cases(86%)with or without halo,and 36 cases(72%)with rich blood supply.FTC: 15 cases(60%)with unclear boundaries,20 cases(80%)with low echo,24 cases(96%)with or without halo,and 23 cases(92%)with rich blood flow signals.The comparative analysis of the three groups of data showed that there were significant differences among groups A,B and C in nodular echo,boundary,halo ring and abundant blood flow.There was nosignificant difference in whether the nodules were accompanied with calcification and whether the nodules were solid or not.2.Clinical characteristicsFTA: 7 males(30.4%),16 females(69.6%),male: female = 1: 2.29.The age range was 22-64 years,the median age was 49 years,7 cases(30.4%)were younger than 45 years,and 16 cases(69.6%)were 45 or more.The maximum diameter of nodules was less than 4cm in 9 cases(39.1%)and ? 4cm in 14 cases(60.9%).The level of Tg was higher than the normal upper limit in 10 cases(43.5%).FT-UMP: 20 males(40%),30 females(60%),male: female = 2: 3.The age range was 21-76 years,the median age was 47 years,19 cases(38%)were younger than 45 years old,and 31 cases(62%)were 45 or older.The maximum diameter of nodules was less than 4cm in 27 cases(54%)and ? 4cm in 23 cases(46%).The Tg level was higher than the normal upper limit in 37 cases(74%).FTC: 6 males(24%)and 19 females(76%).The age range was 12 Mel 73 years old,the median age was 51 years old,12 cases(48%)were less than 45 years old,and 13 cases(52%)were ? 45 years old.The maximum diameter of nodules was less than 4cm in 9 cases(36%)and? 4cm in 16 cases(64%).The Tg level was higher than the normal upper limit in 19 cases(76%).Comparative analysis of the data of group A,B and C showed thatcompared with FTA and FT-UMP,the proportion of patients with thyroglobulin level higher than the normal upper limit in FTC group was higher,and the difference was statistically significant.There was no significant difference in the maximum diameter,age and sex of nodules among the three groups.3.SurgeryFTA:Total thyroidectomy was performed in 4 cases,ipsilateral lobectomy with or without isthmus resection in 7 cases,subtotal lobectomy plus subtotal lobectomy in 1 case,subtotal or subtotal lobectomy in 7 cases,bilateral subtotal lobectomy in 2 cases,and other surgical methods in 2 cases.Lymph node dissection in the central group was performed in 3 cases.All patients were treated with endocrine therapy(oral levothyroxine).FT-UMP:Total thyroidectomy was performed in 7 cases,ipsilateral lobectomy with or without isthmus resection in 21 cases,ipsilateral lobectomy plus contralateral subtotal lobectomy in 10 cases,subtotal or subtotal lobectomy in 9 cases,bilateral subtotal lobectomy in 1 case,and other surgical methods in 2 cases.Lymph node dissection in the central group was performed in 17 cases.All patients were treated with endocrine therapy(oral levothyroxine).FTC:Total thyroidectomy was performed in 7 cases,ipsilateral lobectomy with or without isthmus resection in 10 cases,ipsilaterallobectomy plus contralateral subtotal lobectomy in 5 cases,subtotal or subtotal lobectomy in 2 cases,and bilateral subtotal lobectomy in 1 case.Lymph node dissection was performed in 15 cases in the central group,of which 3 cases were treated with ipsilateral cervical lymph node dissection at the same time.All patients were treated with endocrine therapy(oral levothyroxine).4.Differences in preoperative,intraoperative and postoperative diagnosisCytopentesis was performed in 16 patients before operation,of which only 5 cases were considered thyroid follicular tumor,and the others were suspected cancer or atypical cell hyperplasia.45(45.9%),52(53.1%)and 1(1.0%)cases were diagnosed as FTA,FT-UMP and FTC during operation,and 23(23.5%),50(51.0%)and 25(25.5%)respectively after operation.Statistical analysis showed that the diagnostic consistency between intraoperative freezing rapid pathology and postoperative paraffin pathology(based on paraffin pathology as the gold standard)was poor.For the patients whose frozen pathology can not be clearly diagnosed,their ultrasonic manifestations and clinicopathological features are analyzed,and it is worthy of clinicians to discuss whether they can make empirical diagnosis and treatment decisions so as to avoid undertreatment or overtreatment.Conclusion:1.The imaging findings under ultrasound are helpful to distinguish FTA,FT-UMP and FTC.2.The level of thyroglobulin has a certain guiding significance for the differentiation of benign and malignant thyroid follicular tumors.3.There was no significant difference in the maximum diameter,age and sex of nodules among the three groups.4.The significance of frozen pathology in the diagnosis of thyroid follicular tumors is relatively small.5.Preoperative ultrasonographic signs and thyroglobulin levels have certain reference value for clinical diagnosis and treatment of patients with thyroid follicular tumor which can not be diagnosed by FNAB and intraoperative pathology.