Analysis Of The Pathological And Clinical Characteristics Of Pregnancy-related Differentiated Thyroid Cancer

Background and Purpose:Differentiated thyroid cancer(DTC)is the most common pathological type of thyroid malignancy and is most commonly seen in women of childbearing age.DTC has been reported to be the second most common pregnancy-related malignancy after breast cancer.Approximately 10%of DTC diagnosed in the reproductive age group occur during pregnancy or 12 months postpartum as pregnancy-associated differentiated thyroid cancer.In this study,patients with pregnancy-associated differentiated thyroid cancer were observed and their pathological and clinical characteristics were analyzed to provide theoretical basis for early diagnosis and rational treatment of patients with pregnancy-associated differentiated thyroid cancer.Method:A total of 315 female patients of childbearing age(age≥20 years,≤45 years,meeting the exclusion inclusion criteria)who were first diagnosed with differentiated thyroid cancer and treated surgically at the Department of Thyroid Surgery,First Hospital of Jilin University from October 2015 to October 2022 were selected for retrospective analysis,of whom 63 patients with pregnancy-related differentiated thyroid cancer served as the observation group and 252 patients with non-pregnancy-related differentiated thyroid cancer patients as the control group.Relevant statistical analysis was performed by SPSS 25.0 to compare the differences between the two groups in terms of tumor distribution,maximum tumor diameter,multifocality,invasion of envelope and surrounding tissues,lymph node metastasis,combined lymphocytic thyroiditis and preoperative thyroid function,and p<0.05 was considered a statistically significant difference.Results:(1)In the observation group,23(36.5%)patients had cancer focus distributed on both sides of the thyroid gland,while 45(17.9%)patients in the control group had cancer focus distributed on both sides of the thyroid gland,and there was a statistical difference in tumor distribution between the two groups(p<0.05);at least one of the cancer focus distributed on both sides of the thyroid gland had micropapillary thyroid cancer.(2)Compared with the control group,the mean value of the maximum tumor diameter in the observation group(1.17 cm vs.0.79 cm)was significantly larger than that in the control group,and the difference was statistically significant(p<0.001).(3)Compared with the control group,the incidence of tumor multifocality in the observation group(63.5%VS 39.3%)was significantly higher than that in the control group,and the difference was statistically significant(p<0.05).(4)In the observation group,52(82.5%)patients had tumor invasion of the capsule and 19(30.2%)patients had tumor invasion of the surrounding tissue structures,while in the control group,193(76.6%)patients had tumor invasion of the capsule and 33(13.1%)patients had tumor invasion of the surrounding tissue structure.Patients who invaded the capsule included patients who invaded the surrounding tissue structures.There was no difference in envelope invasion between the two groups(p>0.05),while there was significant difference in surrounding tissue invasion between the two groups(p<0.05).The incidence of tumor invasion surrounding tissue structures in the observation group(30.2%VS 13.1%)was significantly higher than that in the control group.(5)Compared with the control group,the lymph node metastasis rate in the observation group(84.1%VS 52.0%)was significantly higher than that in the control group,and the difference was statistically significant(p<0.001).(6)There was no statistically significant difference in the combined lymphocytic thyroiditis,preoperative TSH,FT3 and FT4 levels between the two groups compared with the control group(p>0.05).Conclusion:(1)Pregnancy-related factors have an impact on the development of occult thyroid cancer.Ultrasonography and fine-needle aspiration biopsy(FNAB)should be reasonably applied in the early diagnosis to improve the detection rate of micropapillary thyroid cancer.(2)Pregnancy-related factors contribute to the maximum tumor diameter,multifocality,peripheral tissue invasion and lymph node metastasis in patients with differentiated thyroid cancer.Patients with pregnancy-related differentiated thyroid cancer should be closely monitored for changes in their disease,and timely surgical treatment should be adopted.Prophylactic central zone lymph node dissection should be used as a routine procedure to reduce the risk of tumor recurrence and secondary surgery and improve patient prognosis.