Objective: To explore the histopathological factors affecting the stiffness of papillary thyroid carcinoma (PTC). Methods: Ninety-six patients with PTC confirmed by surgery and pathology in Shanxi Bethune Hospital from January 2019 to December 2020 were selected, including 101 nodules. Two-dimensional ultrasound and shear-wave elastography (SWE) were performed before surgery and the average Young's modulus (Emean) of PTC nodules were measured. Histopathological examinations on the nodules were conducted after surgery to decide the lesion size, number of lesions, calcification type, presence or absence of capsular and extracapsular invasion, degree of fibrosis, microvessel density, and number of tumor cells. The correlations between the lesion size, degree of fibrosis, microvessel density, and number of tumor cells and the Emean were analyzed. The Emeans of nodules with different numbers of lesions, presence or absence of capsular and extracapsular invasion, and different pathological calcification types were compared. The multiple linear regression analysis was used to evaluate the histopathological factors influencing the Emean. Results: The ranges of the lesion sizes, degrees of fibrosis, microvascular density, numbers of tumor cells, and the Emeans of the 101 investigated PTC nodules were (1.29±0.95) cm, (30.64±18.37)%, (101.64±30.7) vessels per high power field, (373.52±149.87) cells per high power field, and (36.47±19.62) kPa, respectively. Correlation analysis showed that the lesion size of PTC and the degree of fibrosis were positively correlated with the Emean (r=0.660, P＜0.001; r=0.789, P＜0.001), while the microvessel density was negatively correlated with the Emean (r=-0.198, P=0.047). The Emean of the group with capsular and extracapsular invasion was higher than that of the group without (P=0.014). There were statistical differences in the Emeans among different types of pathological calcification (P＜0.001). The multiple linear regression analysis showed that the lesion size (β=0.325, P＜0.001), degree of fibrosis (β=0.563, P＜0.001), psammoma bodies (β=0.177, P=0.001), stromal calcification (β=0.164, P=0.003), and mixed calcification of both psammoma bodies and stroma (β=0.163, P=0.003) were independent influencing factors for the Emean. The degree of fibrosis had the greatest impact on the Emean. Conclusions: The Emean of PTC lesions was correlated with the histopathological characteristics of PTC. The lesion size, degree of fibrosis, and calcification had significant impact on the Emean, among which the degree of fibrosis had the greatest impact.
目的： 探讨影响甲状腺乳头状癌（PTC）病灶硬度的组织病理因素。 方法： 选取2019年1月至2020年12月在山西白求恩医院经手术病理证实的PTC患者96例，结节101个。术前行二维超声和实时剪切波弹性成像（SWE）检查，并测量PTC结节的杨氏模量平均值（Emean）。术后对PTC结节进行组织病理检测，包括病灶大小、数量、钙化类型、有无被膜及被膜外侵犯、纤维化程度、微血管密度、肿瘤细胞数量。分析病灶大小、纤维化程度、微血管密度、肿瘤细胞数量与Emean的相关性，比较不同病灶数量、有无被膜及被膜外侵犯、不同病理钙化类型间PTC结节的Emean，采用多元线性回归分析评估影响Emean的组织病理因素。 结果： 101个PTC结节病灶大小为（1.29±0.95）cm，纤维化程度为（30.64±18.37）%，微血管密度为（101.64±30.7）条/高倍视野，PTC肿瘤细胞数量为（373.52±149.87）个/高倍视野，Emean为（36.47±19.62）kPa。相关分析显示，PTC病灶大小、纤维化程度与Emean呈正相关（r=0.660，P＜0.001；r=0.789，P＜0.001），PTC微血管密度与Emean呈负相关（r=-0.198，P=0.047）。有被膜及被膜外侵犯组Emean高于无被膜及被膜外侵犯组（P=0.014），不同病理钙化类型的Emean差异有统计学意义（P=0.001）。多元线性回归分析显示，病灶大小（β=0.325，P＜0.001）、纤维化程度（β=0.563，P＜0.001）、砂砾体（β=0.177，P=0.001）、基质钙化（β=0.164，P=0.003）、砂砾体基质混合钙化（β=0.163，P=0.003）对Emean的影响有统计学意义，其中纤维化程度影响最大。 结论： PTC病灶的Emean与组织病理特征有关，病灶大小、纤维化程度及钙化均对Emean有明显影响，其中纤维化程度影响最大。.