甲状腺微小乳头状癌高频超声指标预测 颈部淋巴结转移的价值

Value of high frequency ultrasound index of thyroid micropapillary carcinoma in predicting cervical lymph node metastasis

摘要:

目的 分析甲状腺微小乳头状癌高频超声指标与颈部淋巴结转移（LNM）的相关性，进一步评 价高频超声在预测颈部LNM 中的价值。方法 回顾性分析2016 年1 月—2017 年12 月于陕西省人民医院接 受手术治疗并经术后病理证实的甲状腺微小乳头状癌患者111 例。将患者分为转移组和无转移组。将甲状腺 微小乳头状癌结节的数目、大小、边界、纵横比、内部回声、有无微钙化和结节侵及（或接触）被膜与颈部 LNM 进行单因素分析，并用ROC 曲线评价相关阳性指标。结果 两组患者结节大小、内部微钙化及结节接 触（侵及）包膜比较，差异有统计学意义（P <0.05）。ROC 曲线分析显示，当检测出甲状腺微小乳头状癌结 节≥ 5 mm、合并微钙化及接触（侵及）被膜这3 个指标中的2 项时，预测存在颈部LNM 的曲线下面积最大， 为0.706，其敏感性为71.4%（95% CI ：0.53，0.85），特异性为69.7%（95% CI ：0.58，0.79）。结论 应用甲状腺 结节超声指标进行预测时，当检测出甲状腺微小乳头状癌结节≥ 5 mm、合并微钙化及接触（侵及）被膜这3 个指标中的2 项时，即可提示临床该结节可能存在侵袭性。

Abstract:

Objective To analyze the correlation between high-frequency ultrasound index and lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC), and to evaluate the value of high-frequency ultrasound in predicting cervical lymph node metastasis. Methods A retrospective analysis of 111 patients with PTMC who underwent surgery and confirmed by pathologic diagnosis from January 2016 to December 2017 in Shaanxi Provincial People’s Hospital, including 35 patients with lymph node metastasis and 76 patients without metastasis, was carried out. PTMC nodules number, size, boundary, aspect ratio, internal echo, presence or absence of microcalcification, nodular invasion (capsule or neck LNM) were analyzed by single factor analysis, and ROC curve was used to evaluate the relevant positive indicators. Results There were significant differences in nodule size, internal microcalcification and capsule invasion between the two groups (P < 0.05). ROC curve analysis showed that the area under the curve of LNM in cervical region was the largest (0.706), the sensitivity was 71.4% (95% CI: 0.53, 0.85), and the specificity was 69.7% (95% CI: 0.58, 0.79) when two of the three indicators were detected. Conclusion When thyroid nodules were predicted by ultrasonography, two of the three indicators including thyroid micropapillary carcinoma nodules (>5 mm), combined with microcalcification and invasion of the capsule were detected, suggesting that the nodule might be invasive in clinic.