实用医学杂志 ›› 2026, Vol. 42 ›› Issue (7): 1165-1170.doi: 10.3969/j.issn.1006-5725.2026.07.007
• 肿瘤诊治与预后专栏 • 上一篇
收稿日期:2025-11-10
修回日期:2025-12-13
接受日期:2025-12-17
出版日期:2026-04-10
发布日期:2026-04-13
通讯作者:
王淑敏
E-mail:shuminwang2014@163.com
作者简介:基金资助:
Chong HE,Yongyue ZHANG,Shumin WANG(
)
Received:2025-11-10
Revised:2025-12-13
Accepted:2025-12-17
Online:2026-04-10
Published:2026-04-13
Contact:
Shumin WANG
E-mail:shuminwang2014@163.com
摘要:
根据新版甲状腺肿瘤病理分类,滤泡源性肿瘤(FDN)涵盖良性、低风险及恶性亚型,其中恶性FDN(主要包含甲状腺滤泡癌及嗜酸细胞癌)预后显著劣于前者。然而,目前超声风险分层系统及穿刺活检对FDN均难以实现精准的良恶性鉴别。近年来,超声造影与弹性成像等其他超声成像技术的广泛应用为FDN的术前良恶性鉴别提供了可能,已涌现出大量相关研究尝试解决FDN的术前鉴别这一热点与难点问题。基于此,本文就不同模态的超声技术对FDN诊断的难点及研究进展作综述。
中图分类号:
贺崇,张勇跃,王淑敏. 甲状腺滤泡源性肿瘤超声诊断的难点及研究进展[J]. 实用医学杂志, 2026, 42(7): 1165-1170.
Chong HE,Yongyue ZHANG,Shumin WANG. Difficulties and research progress in ultrasonic diagnosis of follicular cell-derived thyroid neoplasms[J]. The Journal of Practical Medicine, 2026, 42(7): 1165-1170.
| [1] |
HUANG Q, XIE L, HUANG L, et al. Development and Validation of an Ultrasonic Diagnostic Model for Differentiating Follicular Thyroid Carcinoma from Follicular Adenoma[J]. Int J Gen Med, 2021, 14: 5069-5078. doi: 10.2147/IJGM.S331338 .
doi: 10.2147/IJGM.S331338 |
| [2] |
BALOCH Z W, ASA S L, BARLETTA J A, et al. Overview of the 2022 WHO Classification of Thyroid Neoplasms[J]. Endocr Pathol, 2022, 33(1): 27-63. doi: 10.1007/s12022-022-09707-3 .
doi: 10.1007/s12022-022-09707-3 |
| [3] |
XU R, WEN W, ZHANG Y, et al. Diagnostic significance of ultrasound characteristics in discriminating follicular thyroid carcinoma from adenoma[J]. BMC Med Imaging, 2024, 24(1): 299. doi: 10.1186/s12880-024-01477-0 .
doi: 10.1186/s12880-024-01477-0 |
| [4] |
LIN Y, LAI S, WANG P, et al. Performance of current ultrasound-based malignancy risk stratification systems for thyroid nodules in patients with follicular neoplasms[J]. Eur Radiol, 2022, 32(6): 3617-3630. doi: 10.1007/s00330-021-08450-3 .
doi: 10.1007/s00330-021-08450-3 |
| [5] |
CASTELLANA M, PICCARDO A, VIRILI C, et al. Can ultrasound systems for risk stratification of thyroid nodules identify follicular carcinoma?[J]. Cancer Cytopathol, 2020, 128(4): 250-259. doi: 10.1002/cncy.22235 .
doi: 10.1002/cncy.22235 |
| [6] |
LIU B J, LIU Y Y, WAN J, et al. New Thyroid Imaging Reporting and Data System (TIRADS) Based on Ultrasonography Features for Follicular Thyroid Neoplasms: A Multicenter Study [J]. Ultrasound Med Biol, 2025, 51(8): 1343-1351. doi: 10.1016/j.ultrasmedbio.2025.05.004 .
doi: 10.1016/j.ultrasmedbio.2025.05.004 |
| [7] |
王炳帝, 隋阳, 吴长君. 超声成像对甲状腺滤泡性肿瘤良恶性诊断的研究进展[J]. 中华医学超声杂志(电子版), 2021, 18(9): 898-900. doi: 10.3877/cma.j.issn.1672-6448.2021.09.016 .
doi: 10.3877/cma.j.issn.1672-6448.2021.09.016 |
| [8] |
张雅娇, 郑雨欣, 徐栋. 多模态超声和人工智能技术对甲状腺滤泡性肿瘤鉴别诊断的研究进展[J]. 肿瘤学杂志, 2023, 29(11): 953-958. doi: 10.11735/j.issn.1671-170X.2023.11.B010 .
doi: 10.11735/j.issn.1671-170X.2023.11.B010 |
| [9] |
PARK H, HEO J, KI C S, et al. Selection Criteria for Completion Thyroidectomy in Follicular Thyroid Carcinoma Using Primary Tumor Size and TERT Promoter Mutational Status[J]. Ann Surg Oncol, 2023, 30(5): 2916-2925. doi: 10.1245/s10434-022-13089-5 .
doi: 10.1245/s10434-022-13089-5 |
| [10] |
CRACOLICI V, RITTERHOUSE L L, SEGAL J P, et al. Follicular Thyroid Neoplasms: Comparison of Clinicopathologic and Molecular Features of Atypical Adenomas and Follicular Thyroid Carcinomas[J]. Am J Surg Pathol, 2020, 44(7): 881-892. doi: 10.1097/PAS.0000000000001489 .
doi: 10.1097/PAS.0000000000001489 |
| [11] |
EMECHEBE D Y, PATIL S A, COLLINS T, et al. Analyzing the impact of molecular testing on the cytological diagnosis of thyroid nodules: Insights from our institution's experience[J]. J Cancer cytopathology, 2025, 133(11): e70051. doi: 10.1002/cncy.70051 .
doi: 10.1002/cncy.70051 |
| [12] |
PARK K W, SHIN J H, HAHN S Y, et al. Ultrasound-guided fine-needle aspiration or core needle biopsy for diagnosing follicular thyroid carcinoma?[J]. Clin Endocrinol (Oxf), 2020, 92(5): 468-474. doi: 10.1111/cen.14167 .
doi: 10.1111/cen.14167 |
| [13] |
NOH B J, KIM W J, KIM J Y, et al. Risk Stratification of Thyroid Nodules Diagnosed as Follicular Neoplasm on Core Needle Biopsy[J]. Endocrinol Metab (Seoul), 2025, 40(4): 610-622. doi: 10.3803/EnM.2024.2256 .
doi: 10.3803/EnM.2024.2256 |
| [14] |
ZHU Y, LI Y, JUNG C K, et al. Histopathologic Assessment of Capsular Invasion in Follicular Thyroid Neoplasms-an Observer Variation Study[J]. Endocr Pathol, 2020, 31(2): 132-140. doi: 10.1007/s12022-020-09620-7 .
doi: 10.1007/s12022-020-09620-7 |
| [15] |
LIU B J, ZHANG Y F, ZHAO C K, et al. Conventional ultrasound characteristics, TI-RADS category and shear wave speed measurement between follicular adenoma and follicular thyroid carcinoma[J]. Clin Hemorheol Microcirc, 2020, 75(3): 291-301. doi: 10.3233/CH-190750 .
doi: 10.3233/CH-190750 |
| [16] |
MATRONE A, GAMBALE C, PIERONI E, et al. Ultrasound features and risk stratification system in NIFT-P and other follicular-patterned thyroid tumors[J]. Eur J Endocrinol, 2023, 189(2): 175-182. doi: 10.1093/ejendo/lvad095 .
doi: 10.1093/ejendo/lvad095 |
| [17] |
CHO Y Y, AHN S H, LEE E K, et al. Malignancy Risk of Follicular Neoplasm (Bethesda IV) With Variable Cutoffs of Tumor Size: A Systemic Review and Meta-Analysis[J]. J Clin Endocrinol Metab, 2024, 109(5): 1383-1392. doi: 10.1210/clinem/dgad684 .
doi: 10.1210/clinem/dgad684 |
| [18] |
SHEN J, YAN M, CHEN L, et al. Prognosis and influencing factors of follicular thyroid cancer[J]. Cancer Med, 2024, 13(1): e6727. doi: 10.1002/cam4.6727 .
doi: 10.1002/cam4.6727 |
| [19] |
AHN H S, KIM H S, HONG M J. Ultrasonographic and cytologic assessments of follicular neoplasms of the thyroid: Predictive features differentiating follicular carcinoma from follicular adenoma[J]. PLoS One, 2022, 17(7): e0271437. doi: 10.1371/journal.pone.0271437 .
doi: 10.1371/journal.pone.0271437 |
| [20] |
ZHANG F, MEI F, CHEN W, et al. Role of Ultrasound and Ultrasound-Based Prediction Model in Differentiating Follicular Thyroid Carcinoma From Follicular Thyroid Adenoma[J]. J Ultrasound Med, 2024, 43(8): 1389-1399. doi: 10.1002/jum.16461 .
doi: 10.1002/jum.16461 |
| [21] |
KUO T C, WU M H, CHEN K Y, et al. Ultrasonographic features for differentiating follicular thyroid carcinoma and follicular adenoma[J]. Asian J Surg, 2020, 43(1): 339-346. doi: 10.1016/j.asjsur.2019.04.016 .
doi: 10.1016/j.asjsur.2019.04.016 |
| [22] |
YUAN Y, SHU H, LI L, et al. A new scoring system for risk stratification of thyroid tumors[J]. BMC Med Imaging, 2025, 25(1): 114. doi: 10.1186/s12880-025-01633-0 .
doi: 10.1186/s12880-025-01633-0 |
| [23] |
BELL C, WHITE S L, TYLEE T, et al. Thyroid Nodule Sphericity Metrics Discriminate Benign and Malignant Follicular and Oncocytic Neoplasms[J]. Thyroid, 2025, 35(3): 291-297. doi: 10.1089/thy.2024.0670 .
doi: 10.1089/thy.2024.0670 |
| [24] |
SILLERY J C, READING C C, CHARBONEAU J W, et al. Thyroid follicular carcinoma: Sonographic features of 50 cases [J]. AJR Am J Roentgenol, 2010, 194(1): 44-54. doi: 10.2214/AJR.09.3195 .
doi: 10.2214/AJR.09.3195 |
| [25] |
ZHANG J Z, HU B. Sonographic features of thyroid follicular carcinoma in comparison with thyroid follicular adenoma[J]. J Ultrasound Med, 2014, 33(2): 221-227. doi: 10.7863/ultra.33.2.221 .
doi: 10.7863/ultra.33.2.221 |
| [26] |
ZHANG Y, MEI F, HE X, et al. Reconceptualize tall-cell variant papillary thyroid microcarcinoma: From a "sonographic histology" perspective[J]. Front Endocrinol (Lausanne), 2022, 13: 1001477. doi: 10.3389/fendo.2022.1001477 .
doi: 10.3389/fendo.2022.1001477 |
| [27] |
LI W, SONG Q, LAN Y, et al. The Value of Sonography in Distinguishing Follicular Thyroid Carcinoma from Adenoma[J]. Cancer Manag Res, 2021, 13: 3991-4002. doi: 10.2147/CMAR.S307166 .
doi: 10.2147/CMAR.S307166 |
| [28] |
SHIN H S, NA D G, PAIK W, et al. Malignancy Risk Stratification of Thyroid Nodules with Macrocalcification and Rim Calcification Based on Ultrasound Patterns[J]. Korean J Radiol, 2021, 22(4): 663-671. doi: 10.3348/kjr.2020.0381 .
doi: 10.3348/kjr.2020.0381 |
| [29] |
BONFIGLIO R, GRANAGLIA A, GIOCONDO R, et al. Molecular Aspects and Prognostic Significance of Microcalcifications in Human Pathology: A Narrative Review [J]. Int J Mol Sci, 2020, 22(1): 120. doi: 10.3390/ijms22010120 .
doi: 10.3390/ijms22010120 |
| [30] |
SHIN J H, HAN B K, KO E Y, et al. Differentiation of widely invasive and minimally invasive follicular thyroid carcinoma with sonography[J]. Eur J Radiol, 2010, 74(3): 453-457. doi: 10.1016/j.ejrad.2009.03.019 .
doi: 10.1016/j.ejrad.2009.03.019 |
| [31] |
CHUNG J, LEE Y J, CHOI Y J, et al. Clinical applications of Doppler ultrasonography for thyroid disease: Consensus statement by the Korean Society of Thyroid Radiology[J]. Ultrasonography, 2020, 39(4): 315-330. doi: 10.14366/usg.20072 .
doi: 10.14366/usg.20072 |
| [32] |
LI Q, YANG L, YANG L, et al. Utility of Six Ultrasound-Based Risk Stratification Systems in the Diagnosis of AUS/FLUS Thyroid Nodules[J]. Acad Radiol, 2024, 31(1): 131-141. doi: 10.1016/j.acra.2023.04.029 .
doi: 10.1016/j.acra.2023.04.029 |
| [33] |
LI J, LI C, ZHOU X, et al. US Risk Stratification System for Follicular Thyroid Neoplasms[J]. Radiology, 2023, 309(2): e230949. doi: 10.1148/radiol.230949 .
doi: 10.1148/radiol.230949 |
| [34] |
YANG Y P, ZHANG G L, ZHOU H L, et al. Diagnostic efficacy of the contrast-enhanced ultrasound thyroid imaging reporting and data system classification for benign and malignant thyroid nodules[J]. Quant Imaging Med Surg, 2024, 14(8): 5721-5736. doi: 10.21037/qims-24-457 .
doi: 10.21037/qims-24-457 |
| [35] |
许魁, 周军. 超声微泡在甲状腺癌诊疗中的研究进展[J]. 实用医学杂志, 2025, 41(3): 454-458. doi: 10.3969/j.issn.1006-5725.2025.03.023 .
doi: 10.3969/j.issn.1006-5725.2025.03.023 |
| [36] |
WU Q, QU Y, LI Y, et al. Logistic regression analysis of contrast-enhanced ultrasound and conventional ultrasound of follicular thyroid carcinoma and follicular adenoma[J]. Gland Surg, 2021, 10(10): 2890-2900. doi: 10.21037/gs-21-535 .
doi: 10.21037/gs-21-535 |
| [37] |
ZHANG C, LIU Z L, WEI Z H, et al. The value and sensitivity of contrast-enhanced ultrasonography combined with fine-needle aspiration biopsy in the diagnosis of thyroid nodules[J]. Sci Rep, 2024, 14(1): 29633. doi: 10.1038/s41598-024-80447-6 .
doi: 10.1038/s41598-024-80447-6 |
| [38] |
XIN Y, LI K, HUANG M, et al. Biophysics in tumor growth and progression: from single mechano-sensitive molecules to mechanomedicine[J]. Oncogene, 2023, 42(47): 3457-3490. doi: 10.1038/s41388-023-02844-x .
doi: 10.1038/s41388-023-02844-x |
| [39] |
HADJIGEORGIOU A G, STYLIANOPOULOS T. Evaluation of growth-induced, mechanical stress in solid tumors and spatial association with extracellular matrix content[J]. Biomech Model Mechanobiol, 2023, 22(5): 1625-1643. doi: 10.1007/s10237-023-01716-3 .
doi: 10.1007/s10237-023-01716-3 |
| [40] |
NIA H T, LIU H, SEANO G, et al. Solid stress and elastic energy as measures of tumour mechanopathology[J]. Nat Biomed Eng, 2016, 1(1): 0004. doi: 10.1038/s41551-016-0004 .
doi: 10.1038/s41551-016-0004 |
| [41] |
SWAN K Z, NIELSEN V E, BONNEMA S J. Evaluation of thyroid nodules by shear wave elastography: A review of current knowledge[J]. J Endocrinol Invest, 2021, 44(10): 2043-2056. doi: 10.1007/s40618-021-01570-z .
doi: 10.1007/s40618-021-01570-z |
| [42] |
RAGO T, SCUTARI M, LOIACONO V, et al. Low Elasticity of Thyroid Nodules on Ultrasound Elastography Is Correlated with Malignancy, Degree of Fibrosis, and High Expression of Galectin-3 and Fibronectin-1[J]. Thyroid, 2017, 27(1): 103-110. doi: 10.1089/thy.2016.0341 .
doi: 10.1089/thy.2016.0341 |
| [43] |
李刚, 贾超, 刘龙, 等. SE及SWE技术对≤1 cm的TI-RADS 4类甲状腺结节的鉴别诊断价值[J]. 肿瘤影像学, 2022, 31(3): 275-280. doi: 10.19732/j.cnki.2096-6210.2022.03.010 .
doi: 10.19732/j.cnki.2096-6210.2022.03.010 |
| [44] |
SAMIR A E, DHYANI M, ANVARI A, et al. Shear-Wave Elastography for the Preoperative Risk Stratification of Follicular-patterned Lesions of the Thyroid: Diagnostic Accuracy and Optimal Measurement Plane[J]. Radiology, 2015, 277(2): 565-573. doi: 10.1148/radiol.2015141627 .
doi: 10.1148/radiol.2015141627 |
| [45] |
那子悦, 乔强, 王秋程, 等. 甲状腺剪切波弹性成像假性结果二维超声特点的分析[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31(15): 1191-1195. doi: 10.13201/j.issn.1001-1781.2017.15.012 .
doi: 10.13201/j.issn.1001-1781.2017.15.012 |
| [1] | 周游,陈纪飞,何希,刘爱梅,杨小兵,黄一芳. 运用机器学习构建肺癌与肺结核鉴别诊断模型[J]. 实用医学杂志, 2026, 42(7): 1158-1164. |
| [2] | 李凯,王兴,曾治军,程序,石波. 经直肠实时组织弹性成像联合MRI在前列腺良恶性病变诊断中的应用及影像学特点[J]. 实用医学杂志, 2026, 42(6): 1070-1077. |
| [3] | 吴胜利,谢爱霞,雒肖艳,赵岩,王福刚,伊力哈木·吐尼亚孜null. 促甲状腺激素受体抗体滴度动态变化联合甲状腺超声弹性成像对Graves病复发风险的预警价值[J]. 实用医学杂志, 2026, 42(6): 991-998. |
| [4] | 尹美霞,汤捷,赵静,杨斌. 子宫动脉血流动力学指标联合弹性成像评分在诊断子宫肌瘤变性中的价值[J]. 实用医学杂志, 2026, 42(1): 29-36. |
| [5] | 郭二芳,冯蕾,石超会,李宁,林伟群,张树华. 基于经会阴三维超声联合剪切波弹性成像的肛提肌形态及弹性对女性压力性尿失禁诊断模型的构建及效果评价[J]. 实用医学杂志, 2025, 41(8): 1224-1231. |
| [6] | 申佳琦,康彧,南绪红,沙晓溪. 彩色多普勒联合实时剪切波弹性成像在诊断血管性勃起功能障碍中的应用价值[J]. 实用医学杂志, 2025, 41(6): 877-881. |
| [7] | 蔡敏绥,崔琪,丁苏君,倪雪君. 宫颈剪切波弹性成像联合宫颈长度及宫颈前角评估宫颈机能状态并预测自发性早产的应用价值[J]. 实用医学杂志, 2025, 41(6): 896-903. |
| [8] | 吴昌慧,黄志平,戴慧萍,邱慧芳,何春,唐芳. 超声造影联合TERT启动子突变构建列线图模型对PTMC并发颈部淋巴结转移的预测效能[J]. 实用医学杂志, 2025, 41(5): 756-765. |
| [9] | 许魁,周军. 超声微泡在甲状腺癌诊疗中的研究进展[J]. 实用医学杂志, 2025, 41(3): 454-458. |
| [10] | 刘钊,李慧,王敏敏,王坤,刘菲菲,王玉华,张文晓. 黏弹性成像联合剪切波弹性成像在乳腺癌诊断中的价值评估[J]. 实用医学杂志, 2025, 41(18): 2806-2811. |
| [11] | 张欣然,沈燕,胡姣姣,陈庆庆,肖杨杰,卢峰,袁沙沙,傅晓红. 联合临床及超声多参数构建列线图预测人表皮生长因子受体2阳性乳腺癌的应用价值[J]. 实用医学杂志, 2025, 41(18): 2812-2819. |
| [12] | 莫敏,林静静,卢鑫,卢瑾. 超声造影参数联合血清CXCL9、IGFBP-3对肝癌介入治疗后复发的预测价值[J]. 实用医学杂志, 2025, 41(16): 2568-2574. |
| [13] | 徐泽林,郑振浩,邓雅倩,曾冠明,杜婷婷,朱佩珊,刘文,李军. 弹性相对指数联合S-Detect对甲状腺乳头状癌颈部淋巴结转移的预测价值[J]. 实用医学杂志, 2025, 41(16): 2581-2589. |
| [14] | 史晓峰,莫春柏. 超声造影在胰腺移植中的研究进展[J]. 实用医学杂志, 2024, 40(8): 1171-1174. |
| [15] | 赵敏,倪平,翟惠莹,靳小可,杨玉琼. 淋巴样增强结合因子1在B细胞慢性淋巴增殖性疾病中的表达[J]. 实用医学杂志, 2024, 40(7): 984-988. |
| 阅读次数 | ||||||
|
全文 |
|
|||||
|
摘要 |
|
|||||

