Ultrasonographic Study Of Medullary Thyroid Carcinoma

Objective The target of the study is ultrasonographic features of medullary thyroid carcinoma(MTC).Here are five points:(1)the gray-scale ultrasound image characteristics of MTC nodules;(2)the color doppler flow imaging characteristics of MTC nodules;(3)the ultrasonographic characteristics and metastatictendency of MTC cervical metastasis lymphnodes;(4)the various calcification characteristics of MTC nodules;(5)the ultrasonic elastic imaging characteristics of MTC nodules.Methods1 Preparation before the study(1)Refer to frontier literatures in the diagnosis and treatment of MTC between domestic and overseas,especially,in the field of ultrasonic diagnosis.(2)Be familiar with the diagnostic techniquesof MTC including calcitonin(Ct),carcinoembryonic antigen(CEA),Ultrasonography,CT,MRI,Nuclear Medicine,PET/CT,Biopsy and Gene Detection.(3)Understand the treatment methods of MTC,including traditional surgical treatment methods and the latest nonsurgical treatment.Surgical treatment is the treatment of MTC primary lesions,metastasis lymph nodes and lesions etc.Non-surgical treatment include medication,radionuclide therapy,radiation therapy and molecular targeted therapies.(4)Update theoretical knowledge of ultrasoundintimately and be skilled in the use,function and operationof various instruments.(5)write reviews of MTC.(6)design and plan research project.2 Research(1)Collection of cases.The postoperative pathology of the Shenzhen second people's hospital was obtained and the preoperative ultrasonographic images stored in the same hospitalduring the research paper.There were 41 patients with MTC and 48 MTC nodules.(2)Analysis of gray-scale sonographic findings in 38 cases of 45 MTC nodules,including the number of MTC nodules(single,multiple),age(maximum age,minimum age,average age,median age),sex(male,female),primary lesion and location(left lobe of thyroid,right lobe of thyroid,isthmus of thyroid,pyramidal lobe of thyroid;Upper pole,middle,lower pole;Shallow,middle and deep),nodule(maximum diameter),the size of the aspect ratio(greater than or equal to 1,less than 1),shape(circle,elliptic,ovoid,irregular shape),boundary(clear,unclear),edge(finishing,not only the whole),internal echo(low echo,very low echo,middle low echo,equal echo,high echo),calcification(with and without),acoustic halo(with and without,wide or narrow,uniform and non-uniform),cystic change(with and without),rear echo(normal,enhancement,attenuation);The gray-scale sonographic images of 162 thyroid papillary carcinomas(PTC)nodules were controlled in comparison with randomly selected 143 patients.(3)Analysis of 38 cases of 45 MTC nodules ultrasonographic color doppler flow imaging,including the nodal flow pattern(type I,II,III,IV),annular flow surrounding the nodules(with,without),nodules internal blood flow abundance(rich,not rich),nodules internal blood flow distribution(rules and irregular).(4)Analysis of the ultrasonography and metastasis of cervical metastatic lymph nodes in 38 patients with MTC patients;Including the presence of lymph node metastasis,metastasis of lymph node ultrasonic ultrasonograph,lymph node metastasis of area(area I,II,III,VI,V,VI,VII,including central,side on the neck area,under the chin and jaw area,mediastinal area,including VI area for the central region,II,III,IV,V area for lateral neck area,I area under the chin and jaw area,VII zone for mediastinal area).(5)Analysis of 41 cases of 48 MTC various calcified nodules on sonograms,including the presence of calcification,calcification type(calcification are divided into simple internal coarse calcification,internal coarse calcification with micro-calcification,scattered micro-calcification,inner clusters of microcalcification,internal dispersion micro-calcification,pure edges calcification,simple peripheral calcification,edgecoarse calcification combining microcalcification,coarse calcification around combining micro-calcification);In contrast to the total of 198 PTC nodules in 173 patients at the same time,various calcification were compared.(6)The elastic ultrasonic image of 20 cases of 24 MTC nodules was analyzed,and the image score was graded 5.The elastic imaging of 87 PTC nodules in66 patients was compared with that of randomly selected patients.Results1 The difference between MTC and PTC in nodule size(maximum diameter),site,location,boundary,aspect ratio and rear echo(p < 0.05);The MTC nodules are relatively large,which are located in the upper and middle of thyroid,and the boundary is clear,and the aspect ratio is less than 1,and the echo attenuation is rare in the rear.There was no statistically significant difference between MTC and PTC in gender,age,number,edge,shape,echo,acoustic halo and cystic change(p> 0.05).2 In the study of the blood flow pattern of 45 MTC nodules in 38 cases,there were 8 cases of the type I,accounting for 17.7%.There are four cases of the type II,accounting for about 8.9%.There are 8 cases of the type III,accounting for 17.7%.There are 25 cases of the type IV,accounting for 55.7%.MTC nodules are mostly rich in blood flow,whether central or marginal.The nodules were rich in 37,accounting for 82.2%.There is not abundant blood and no blood flow signal sin the nodules,accounting for 17.8%.There were 6 cases circulating blood flow around nodules,accounting for 13.3%,and no annular blood flow was 86.7%.There are 8 cases without blood flow and less blood flow in the interior.The regular distribution are 25 in 37 cases with abundant blood flow,accounting for 67.6 %(25/37),and there are 12 irregular distribution,accounting for 32.4%(12/37).3 In 38 TMC patients,33 cases have metastatic lymph nodes,accounting for86.8%,and no lymph node metastasis was 13.2%.In 33 cases of lymph node metastasis,central lymph node metastasis accounted for 100%.There were 30 cases with III region and IV region lymph node metastasis,which accounts for about 90.9%.There were 21 cases with II region,accounting for about63.6%.There were 16 cases with V zone transfer,accounts for about 48.5%.4 In 41 cases of 48 MTC nodules,12 nodules without calcification(25.0%),9nodules with pure coarse calcification(18.8%),6 nodules with internal rough calcification combined micro-calcification(12.5%),15 nodules with internal scattered micro-calcification(31.2%),no nodules with internal clusters and dispersion micro-calcification(12.5%),no nodules with pure edge and peripheral calcification(0.0%),no nodules with the marginal or peripheral calcification combined with micro-calcification(0.0%);in 198 PTC nodules,25 nodules are without calcification(12.5%),no nodule with pure internal coarse calcification accounts for 0.0%,7 nodules with internal rough calcification combined micro-calcification account for about 3.5%;25 nodules with internal scattered micro-calcification account for about 12.5%;126 nodules with internal dispersion micro-calcification and clusters micro-calcification account for about 63.5%,no nodules with pure edge and peripheral calcification account for about 0.0%;16 nodules with the peripheral or peripheral calcification combined with micro-calcification are about 8.0%;Most MTC nodules are pure internal coarse calcification and scattered micro-calcification,and peripheral edge don't appear calcification;Most PTC nodules are clusters micro-calcification and dispersion micro-calcification,and micro-calcification can merge peripheral coarse calcification,but no nodules are pure internal coarse calcification;In the micro-calcification and dispersion micro-calcification distribution,the difference between the two is statistically significant(x 2 =54.587,P< 0.01).In the distribution of micro-calcification,the difference between the two is statistically significant(x 2 = 9.658,P< 0.01).5 In 20 cases of 24 MTC nodules,elastic score:0(0%)of 0 points,2(8.3%)of 1 point,16(66.7%)of 2 points,5(20.8%)of 3 points,1(4.2%)of 4 points;and in 66 cases of 87 PTC nodules,elastic score : 0(0%)of 0 points,2(2.3%)of 1 points,4(4.6%)of 2 points,44(50.6%)of 3 points,37(42.5%)of 4points;the elastic score of most MTC nodules is 2 points,and elasticity score of PTC nodules are 3 points and 4 points;MTC and PTC nodules showed a significant difference in ultrasound elastography score(x 2 = 101.848,P =<0.05).Conclusion MTC is derived from thyroid parafollicular cells.Different from papillary thyroid carcinoma,it has typical ultrasonic characters as follows: 1)It only grows in specific sites,especially in the deep layer of mid-upper part of the thyroid glands,which is close to the site of parathyroid glands.Many C cells are accumulated around the parathyroid glands,therefore it would be less likely if the nodules appear in the superficial layer or the isthmus part of thyroid glands.2)Lesions are always deep,homogeneous hypoechoic and with clear borders.The aspect ratio is always less than 1.Few calcification or coarse calcification can not be the criteria for excluding MTC.3)The nodules are soft with abundant blood flow,therefore blood flow signals are abundant in color doppler image and scores in elastography are low because of its soft texture.However,its acoustic attenuation is not obvious in gray-scale images.4)Most lesions are low grade tumors with early extensive lymphatic metastasis.Moreover,both MTC and PTC are malignant tumors of thyroid gland.In the aspect of ultrasonic image,MTC has its own characteristics and share some common features with PTC,hence it is difficult to differentiate them.Whether to differentiate benign or malignant tumors or to make a pathological diagnosis,it is necessary to combine with the results of fine needle aspiration biopsy(FNAB)and the level of serum Ct.