收稿日期: 2025-11-10
修回日期: 2025-12-13
录用日期: 2025-12-17
网络出版日期: 2026-04-13
基金资助
国家自然科学基金面上项目(82372561)
Difficulties and research progress in ultrasonic diagnosis of follicular cell-derived thyroid neoplasms
Received date: 2025-11-10
Revised date: 2025-12-13
Accepted date: 2025-12-17
Online published: 2026-04-13
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 . DOI: 10.3969/j.issn.1006-5725.2026.07.007
The updated histopathological classification of thyroid tumors recognizes follicular cell-derived thyroid neoplasms （FDN） as consisting of benign， low-risk， and malignant subtypes. Malignant FDN， mainly follicular thyroid carcinoma and oncocytic carcinoma， are linked to significantly poorer clinical outcomes when compared with benign lesions. However， conventional ultrasound risk stratification systems and fine-needle aspiration biopsy still have limitations in accurately differentiating benign from malignant FDN. In recent years， the incorporation of advanced ultrasound modalities， such as contrast-enhanced ultrasound and elastography， has offered promising ways to enhance preoperative diagnostic accuracy. A burgeoning body of research has aimed to tackle this long-standing challenge in FDN classification. This review outlines current diagnostic limitations and emphasizes recent advancements in the application of ultrasound techniques for the assessment of FDN.
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
| [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 . |
/
| 〈 |
|
〉 |