| ObjectiveTo compare the differences in ultrasound and clinical pathological features between FTC and PTC, and analysis the prognosis and its influencing factors of FTC, to guide the clinical diagnosis and treatment plan of FTC better. MethodsA retrospective analysis of 56 patients with FTC treated in the First Affiliated Hospital of Fujian Medical University from January 2008 to December 2012, 112 patients with PTC were randomly selected as the control group. Analysis included ultrasound features, clinical manifestation, operation way, postoperative pathology in two groups. The FTC group were followed-up, analyze the overall survival analysis and the influence of factors. Results1 UltrasonographyFTC Fuzzy boundary in 11 cases(19.6%), 45 cases with low-echo(80.4%), 24 cases with halo(42.9%), only 10 cases(17.9%) with nodular calcification, 43 cases(76.8%)with internalblood flow signals, nodule maximum diameter 16 cases( 28.6%) of less than or equal to 2cm, 20 cases( 35.7%) of 2-4cm, 20 cases(35.7%) of 4cm.PTC Fuzzy boundary in 61 cases(54.5%), 104 cases with low-echo(92.7%), only 5 cases with halo(4.5%), 86 cases(76.8%) with nodular calcification, 81 cases(72.3%)with internalblood flow signals, nodule maximum diameter 87cases(77.7%)of less than or equal to 2cm, 23 cases(20.5%) of 2-4cm, 2 cases(1.8%) of 4cm.Comparation Comparaed with PTC, boundaries were clear, nodules could be showed high echo, nodular microcalcifications were uncommon, nodules maximum diameter was larger, nodules were surrounded halo in FTC, the difference was significant. While the blood flow signal was rich both in FTC and PTC, the difference was not statistically significant.2 The clinical features and pathological characteristicsFTC Male 26 cases, female 30 cases(1:1.2), aged 19-81 years old, the median age was 43 years, 33 patients(58.9%)aged < 45 years old, 23 patients(41.1%)older than 45(or is 45 years old). 52 cases with single lesion, only 7 cases with lymph node metastasis. 9 cases with distant metastases.PTC Male 21 cases, female 91 cases(1:4.3), aged 16-75 years old, the median age was 44 years, 62 patients(55.4%)aged < 45 years old, 50 patients(44.6%)older than 45(or is 45 years old). 42 cases with single lesion, 63 cases with lymph node metastasis. 3 cases with distant metastases.Comparation Comparaed with PTC, the proportion of men was more, vascular invasion and distant metastasis were more common, single lesion was conmon, and cervical lymph node metastasis was less in FTC,and the difference was significant. While aged<45years old and local recurrence and distant metastase was less both in FTC and PTC, the difference was not statistically significant.3 FTC operation treatment13 cases received total thyroidectomy, 9 cases received near total thyroidectomy, and 13 cases recevied isthmectomy(with or without isthmus resection), 2 cases received subtotal thyroidectomy, 11 cases underwent ipsilateral gland and large gland lobectomy on the other side, 1 cases recevied bilateral near total thyroidectomy,7 cases recevied other operations.27 cases recevied neck lymph node dissection, including central lymph node dissection in 20 cases, cervical lymph node dissection in 2 cases, improved cervical lymph node dissection in 2 cases e, 3 cases didn’t recevied neck lymph node dissection.4 Analysis of prognosis and prognostic factors of FTCThe 3 year cumulative survival rate was 93.8%, 5 year cumulative survival rate of 86.8%.Single factor analysis showed: aged≥45, distant metastasis, TNM staged IV,bilateral or multifocal lessions affected the prognosis. Multivariate analysis showed that only distant metastasis were independent factors affecting the prognosis. Conclusion1. Conventional ultrasound(2D ultrasound and color Doppler ultrasound) :if the image manifestations appear solid hypoechoic nodules or hyperechoic nodules, the still clear border, nodular peripheral a halo ring, internal rich or irregular flow, it should be alert to FTC.2. FTC and PTC are found in women, but a higher proportion of men in FTC. FTC showed single lesions, vascular invasion and distant metastasis and less neck lymph node metastasis or local recurrence metastasis. Multiple lesions were more common in PTC than FTC, and PTC showed more cervical lymph node metastasis, less vascular invasion or distant metastasis.3.FTC operation selection including total / near total thyroidectomy,ipsilateral lobectomy,(with or without isthmus resection), according to clinical stage, cervical lymph node metastasis, distant metastasis and rapid intraoperative frozen. Clinical confirmed cervical lymph node metastasis in patients need thetreatment of neck lymphnode dissection has been reached in different national guides. But for cervical lymph node dissection, the guide were more cautious except china.4.In DTC, FTC have a poor prognosis, metastasis is the independent risk factors affecting theoverall survival. |
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