29岁女子查出1厘米结节，确诊癌症且已转移；同事的结节明明更大却没事？医生提醒

同事的结节1.5cm×1cm，医生说没事，而自己0.8cm×1cm结节竟最终确诊甲状腺癌，且已发生淋巴结转移。

A 29-year-old woman's case has highlighted the importance of evaluating thyroid nodules beyond their size, after a nodule smaller than her colleague's turned out to be cancer that had already spread to lymph nodes.

thyroid /ˈθaɪrɔɪd/：甲状腺

nodule /ˈnɒdjuːl/：结节

node /nəʊd/：节点；结节

双双查出甲状腺结节

一个可观察，一个要穿刺

“你直接拿着报告去找专科医生帮你评估一下。”

在杭州临平区妇幼保健院体检中心，小李在查出甲状腺结节的那一刻，就受到了医护人员的“特殊关注”。

小李心里顿时忐忑不安，拉着同事，找到乳腺（甲状腺）外科副主任汪芬华。

汪主任对小李说：“你的左侧甲状腺结节0.8cm×1cm，不大，但是形态不规则，而且位于上极，需要穿刺一下明确病理。”

同事见状十分不解：“我的结节比她更大，长了好几年都安然无恙，怎么她的小结节反而要进一步检查？”汪主任随即翻看其体检报告解释道：“你的结节虽有1.5cm×1cm，但影像特征稳定良性，只需定期观察即可。”

“为什么比我的大却不用穿刺？”小李惊讶地问。汪主任解释：“甲状腺结节分良、恶性，除大小外，还要看形态、边界、内部回声及位置。你的结节形态不规则、纵横比失调，TI-RADS:4A，有恶性可能。甲状腺上极的恶性结节容易转移，要积极关注。而你同事的结节形态规则、内部回声均匀、考虑良性概率大，可以随访。”

Wang explained that thyroid nodules can be benign or malignant, and that size alone is not enough to judge risk — shape, margins, internal echoes and location all matter.

Li's nodule was irregular, had an abnormal shape ratio and was classified as TI-RADS 4A, meaning it could be malignant. Malignant nodules in the upper part of the thyroid are more likely to spread, she said, while her colleague's nodule looked regular and even, suggesting it was likely benign.

确诊甲状腺癌

“懒癌”问题不大？

经细针穿刺活检，小李的细胞学结果高度考虑甲状腺乳头状癌；颈部增强CT提示甲状腺左侧叶结节灶恶性病变可能，左侧颈Ⅱ、Ⅲ、Ⅳ区、颈Ⅵ区气管前方及左侧缘多发淋巴结异常，存在转移风险！

手术完整切除左侧甲状腺腺叶，彻底清扫可疑淋巴结，23枚中5枚转移。术后，小李恢复良好，目前已出院。

由于部分甲状腺癌生长相对缓慢、总体预后较好，因此被认为是“懒癌”，没什么大问题。

汪主任提醒，甲状腺癌最常见的类型是乳头状癌，虽总体预后较好，但仍具有发生颈部淋巴结转移的可能。

Because some thyroid cancers grow slowly and generally have a good prognosis, they are sometimes called "lazy cancer" and dismissed as not serious. Wang cautioned that papillary carcinoma, the most common type, can still spread to lymph nodes in the neck despite its relatively good outlook.

结节小、无症状

也不能忽视

很多人觉得：“结节不到1cm，能有什么问题？”

事实上，评估结节风险不能只盯着毫米数值，需要综合观察结节的形态、边界、回声、钙化等影像学特征，同时结合年龄、既往病史、颈部淋巴结情况等进行综合研判。

Many people assume a nodule under 1 cm is nothing to worry about. In fact, assessing risk requires looking at the nodule's shape, margins, echoes and calcification, as well as the patient's age, medical history and lymph nodes.

甲状腺拥有丰富的淋巴引流网络，部分甲状腺癌可经淋巴途径发生颈部淋巴结转移；同时，肺、骨骼也是甲状腺癌较为常见的远处转移部位。当体检发现可疑甲状腺结节时，应当结合临床及影像学资料进一步评估。

The thyroid has a rich lymphatic network, and some thyroid cancers can spread to lymph nodes in the neck. The lungs and bones are also common sites of distant spread. Suspicious nodules should be further evaluated.

注意！颈部淋巴结肿大不等于肿瘤转移，炎症、感染等良性病变同样会造成淋巴结增大。是否存在淋巴结转移，需要专科医生结合超声、增强CT，必要时穿刺病理等结果综合判定。

Doctors also noted that swollen lymph nodes in the neck do not necessarily mean cancer spread — inflammation and infection can also cause them to enlarge. Whether cancer has spread requires a specialist to judge based on ultrasound, enhanced CT and, when necessary, biopsy results.

来源：光明网