目的:探讨甲状腺乳头状癌（papillary thyroid carcinoma,PTC）中多灶癌与单灶癌的临床病理特征及超声表现的差异。方法:分析2007年1月至2019年1月于我院行超声检查并接受甲状腺全切手术的448例PTC患者,其中单灶癌患者155例（单灶组）,多灶癌患者293例（多灶组）,采用χ²检验及非参数检验比较单灶组与多灶组之间的临床病理特征及超声表现差异。结果:在临床病理特征方面,PTC多灶组中微小癌（72%比63%,P=0.049）、淋巴结转移（56%比41%,P=0.004）及包膜浸润（10%比3%,P=0.009）显著多于单灶组,而合并结节性甲状腺肿情况比单灶组少（42%比56%,P=0.003）。在超声表现方面,相较于单灶组,多灶组中癌结节更易出现在甲状腺中央背侧及中间外侧（P值分别为0.029、0.008,P值分别为0.002、0.011）,3根径线（上下径、前后径、左右径）长度均显著小于单灶组（P值分别为0.004、0.001、0.023）,而多灶组中边界模糊（67%比77%,P=0.013）、内部回声不均匀（79%比88%,P=0.009）、钙化（50%比63%,P=0.010）及后方回声改变(18%比28%,P=0.008）的结节少于单灶组。结论:多灶性PTC患者中发生淋巴结转移及包膜浸润者更多,可以进行相对更积极的治疗;超声表现比较分析显示,相对于单灶性PTC,多灶性PTC结节更易出现在甲状腺中央背侧及中间外侧,且癌灶体积较小,因此医师应对其更加重视,减少漏诊、误诊。

Objective: To investigate the difference in the clinicopathologic and ultrasonic features between unifocal and multifocal papillary thyroid carcinomas. Methods: A total of 448 cases with papillary thyroid carcinoma undergone total thyroidectomy were enrolled during Jan. 2007 to Jan. 2019. Patients were divided into two groups which were unifocal tumor group (155 cases) and multifocal tumor group (293 cases). The difference in clinicopathologic and ultrasonic features between two groups were compared using χ² test and non-parametric tests. Results: The pathological examination revealed that the multifocal tumors presented more microcarcinoma (72% vs 63%, P=0.049), lymph node metastasis （LMN） (56% vs 41%, P=0.004), capsular invasion (10% vs 3%, P=0.009) and less nodular goiter （42% vs 56%, P=0.003） than those of unifocal tumors. Comparing to unifocal tumors, the multifocal tumors occurred more in the middle dorsal and medial lateral side of the thyroid （P=0.029, P=0.008; P=0.002, P=0.011）, and their size measured with three diameters(vertical anteroposterior, left right diameters) was smaller (P=0.004, P=0.001, P=0.023) in ultrasonography. In addition, the multifocal group had less unclear boundary (67% vs 77%, P=0.013), heterogeneous internal echoes (79% vs 88%, P=0.009), calcification (50% vs 63%, P=0.010) and pos-terior echo change （18% vs 28%, P<0.008） than the unifocal group. Conclusions: The multifocal tumors have more LNM and capsular invasion, presenting more aggressive clinicopathological features, which means active management may be required. The ultrasonic imaging shows multifocal tumors tend to locate in the middle dorsal and medial lateral side of the thyroid and the size of them are smaller, which makes it easy to lead to the missed diagnosis or misdiagnosis. Therefore, more attention should be given to it in clinical practice.