甲状腺微小乳头状癌临床及超声特征与中央区淋巴结转移的危险因素

Clinical and ultrasonic features of papillary thyroid microcarcinoma and risk factors for central lymph node metastasis

目的:探讨甲状腺微小乳头状癌(PTMC)的临床及超声特征与中央区淋巴结(CLN)转移的危险因素,为个体化治疗提供帮助。方法:经手术病理确定为PTMC,并预防性清扫CLN的患者185例,根据淋巴结是否转移,将其分为转移组与未转移组,分析其肿块大小、形态、回声、纵横比、边缘、是否突出包膜、结节的位置、有无钙化及钙化类型的超声特征及性别、年龄、单发/多发及是否合并桥本甲状腺炎的临床特征与CLN转移(CLNM)的关系。结果:185例PTMC患者中,CLNM患者55例,转移率为30.0%。在单因素分析中,PTMC的CLNM与性别、年龄、肿块大小、是否突出包膜、钙化类型及单发/多发差异均有统计学意义(P<0.05),与纵横比、边缘、内部回声、结节位置、是否合并桥本甲状腺炎差异均无统计学意义(P>0.05)。在多因素Logistic回归分析中,肿块大小、单发/多发、突出包膜、性别及年龄均为CLNM的危险因素。根据ROC曲线显示,当年龄取值49.5岁、肿块大小取值4.8 mm为诊断截点时,诊断试验约登指数取得最大值。结论:当PTMC患者出现男性、≤49.5岁、肿块大小≥4.8 mm、多发及突出包膜的危险因素时,应积极采取治疗措施,对其进行预防性CLN清除。

Objective: To investigate the clinical and ultrasonic features of papillary thyroid microcarcinoma(PTMC) and the risk factors of central lymph node metastasis(CLNM), to provide help for individualized treatment. Methods: One hundred and eighty-five patients with PTMC confirmed by surgery and pathology and underwent prophylactic CLN dissection were retrospectively analyzed. According to lymph node metastasis, patients were divided into metastasis group and non metastasis group. The size, shape, echo, aspect ratio, edge, protruding capsule, nodule location, calcification and calcification were analyzed. The relationship between clnm and ultrasonographic features, sex, age, single/multiple, whether or not with Hashimoto thyroiditis was analyzed. Results: Among 185 patients with PTMC, 55 cases had lymph node metastasis, and the metastasis rate was 30.0%. In univariate analysis, clnm of PTMC was significantly correlated with gender, age, tumor size, protruding capsule, type of calcification and single/multiple(all P<0.05). In multivariate logistic regression analysis, tumor size, single/multiple, protruding capsule, gender and age were the risk factors of clnm. According to the ROC curve, when the age was 49.5 years old and the mass size was 4.8 mm, the diagnostic test yoden index reached the maximum value.Conclusion: When the risk factors of male, ≤49.5 years old, tumor size≥4.8 mm, multiple and protruding capsule appeared in PTMC patients, preventive CLN clearance should be taken actively.