| Objective: To retrospectively analyze the clinical and pathological features of papillary thyroid carcinoma(PTC)with hashimoto’s thyroiditis(HT),and provide more clinical basis for early diagnosis of PTC with HT.Methods: We collected 376 patients of papillary thyroid carcinoma at the first affiliated hospital of university of South China from March 01,2015 to December 31,2018,all of these patients were the first time treated by thyroidectomy and cervical lymph node dissection operation.According to the postoperative pathological results that whether or not combined with Hashimoto’s thyroiditis(also known as chronic lymphatic thyroid),the 376 patients were classified into observation group: papillary thyroid carcinoma with Hashimoto’s thyroiditis group(PTC combined with HT group),and control group:simple papillary thyroid carcinoma group(single PTC group).Then we compared the gender,age,thyroid function,ultrasound characteristics and pathological features of the two groups.Results: 1.There were 376 PTC patients in this study,including 93 patients diagnosed with PTC combined with HT,and 283 patients with simple PTC.The proportion of female of PTC combined with HT was higher than that of simple PTC(89.2% VS 71%),but males’ was lower(10.8% VS 29%),the difference was statistically significant(P< 0.001);the age of onset(43.09±11.847 VS 43±11.854)was not statistically significant(P> 0.05);the proportion of rised serum TgAb and TPOAb(49.5% VS 6.4% and 69.9% VS 7.1%),and the difference was statistically significant(P< 0.001).There was no significant difference in serum TSH between the two groups(P> 0.05).2.The ultrasound characteristics of the two groups were compared:(1)the blood flow signal of the PTC combined with HT group was significantly richer than that of the simple PTC group(70.7% VS 51.6%),the thyroid diffuse enlargement in the PTC combined with HT group was higher than that of the simple PTC group(29.0% VS 0.7%),the difference is statistically significant(P< 0.001);(2)the difference in morphology,echogenicity,calcification,boundary of the cancer nodules,number of nodules,texture,enlarged lymph nodes,TI-RADS classification between the two groups,which was not statistically significant(P> 0.05).3.The pathological features of the two groups were compared:(1)compared to the simple PTC group,the PTC combined with HT group’s tumor size was smaller(1.28cm± 0.92 VS 1.55cm± 1.06),the incidence of microcarcinoma was significantly increased(51.6% VS 39.2%),and the incidence of bilateral PTC(66.7% VS 73.4%),the capsular invasion(6.5% VS 15.2%),vessel invasive(2.2% VS 9.5%)was significantly reduced,the difference was statistically significant(P< 0.05);(2)but the difference between the two groups of the extra-glandular invasion(1.1% VS 3.2%)and multifocal cancer incidence(29% VS 33.2%),which was not statistically significant(P> 0.05),however,in unilateral PTC,the incidence of multifocal cancer was higher in the PTC combined with HT group(33.3% VS 26.6%),and the difference was statistically significant(P< 0.05).(3)The pathological features of cervical central region lymph nodes in the two groups: the ratio of lymph node metastasis in the PTC combined with HT group was lower than that in the simple PTC(0.14±0.22 VS 0.32±0.38),the difference was statistically significant(P< 0.05),but there was no significant difference between the two groups in the presence of lymph node metastasis(44.1% VS 54.4%,P> 0.05).4.(1)Univariate analysis of multifocal PTC risk factors showed that there was no significant association between multifocal PTC and gender,age,and HT(P> 0.05).(2)Univariate analysis results of risk factors for PTC with cervical central lymph nodes metastasis showed that PTC occurred with cervical central lymph node metastasis had correlation with age,tumor size,multifocal carcinoma,capsule invasion and/or extraglandular invasion,the difference was statistically significant(P< 0.05).Multivariate logistic regression analysis,using a stepwise regression,showed that age< 55 years(OR: 0.282,95% CI: 0.141-0.565,P< 0.001),tumor> 1 cm(OR: 3.987,95% CI: 2.532-6.277,P< 0.001),multifocal carcinoma(OR: 1.536,95% CI: 0.399-1.061,P< 0.05)were independent risk factors for central lymph node metastasis in PTC.(3)Multivariate logistic analysis of clinical and pathological data showed that women(OR: 0.369,95% CI: 0.145-0.936,P< 0.05)and increased thyroglobulin antibodies(OR: 6.377,95% CI: 2.892-14.061,P< 0.001),anti-thyroid peroxidase antibody elevation(OR: 19.670,95% CI: 9.822-39.391,P< 0.001),microcarcinoma,tumor diameter≤ 1 cm(OR : 0.427,95% CI: 0.218-0.837,P < 0.05)PTC is more likely to incorporate with HT.Conclusion : 1.Papillary thyroid carcinoma combined with Hashimoto’s thyroiditis was more common in women.Preoperative serum TgAb,TPOAb concentration rised and B-ultrasound indicated diffuse thyroid enlargement,which was helpful for preoperative diagnosis of papillary thyroid carcinoma combined with Hashimoto’s thyroiditis.2.The results of this study showed that thyroid papillary carcinoma combined with Hashimoto’s thyroiditis had smaller tumors,higher incidence of microcarcinoma,lower bilateral glandular involvement rate,lower incidence of capsular invasion,lower lincidence of vascular invasion,and lower central lymph node metastasis rate,which indicated that Hashimoto’s thyroiditis can inhibit the extrathyroidal extension,intrathyroidal and cervical lymph nodes metastasis of papillary thyroid carcinoma to some extent. |
