临床资料及超声表现鉴别诊断儿童腹膜后混杂型与结节型节细胞神经母细胞瘤

Clinical data and ultrasonic findings for differential diagnosis of retroperitoneal ganglioneuroblastoma-intermixed and ganglioneuroblastoma-nodular in children

目的观察以临床及超声表现鉴别儿童腹膜后混杂型(GNBi)与结节型(GNBn)节细胞神经母细胞瘤的价值。方法回顾性分析73例腹膜后节细胞神经母细胞瘤(GNB)患儿,根据病理结果将其分为GNBi组(n=42)和GNBn组(n=31);比较组间临床资料包括年龄、性别、尿香草基扁桃酸(VMA)、血神经元特异性烯醇化酶(NSE)和骨髓穿刺结果,以及超声表现如肿瘤形态、最大径、边界、有无液化、是否包绕腹膜后大血管、是否跨越中线、内部回声、是否出现钙化及钙化类型及Alder血流分级;行二元logistic回归分析,绘制受试者工作特征曲线,计算曲线下面积(AUC),评估根据临床及超声表现鉴别不同病理类型GNB的效能。结果组间血清NSE、骨髓穿刺结果、肿瘤钙化类型及Adler血流分级差异均有统计学意义(P均<0.05)。以病理结果为金标准,单一基于年龄、肿瘤钙化类型及Alder血流分级及联合应用上述三项鉴别GNB病理类型的AUC分别为0.619、0.702、0.611及0.864,三项联合高于任意单一项(P均<0.05)。结论联合应用年龄、肿瘤钙化类型及Alder血流分级有助于鉴别不同病理类型儿童GNB。

Objective To observe the value of clinical data and ultrasonic findings for distinguishing retroperitoneal ganglioneuroblastoma-intermixed(GNBi)and ganglioneuroblastoma-nodular(GNBn)in children.Methods Data of 73 children with ganglioneuroblastoma(GNB)were retrospectively analyzed.The children were divided into GNBi group(n=42)or GNBn group(n=31)based on pathological results.Clinical data,including age,gender,urinary vanillylmandelic acid(VMA),blood neuron specific enolase(NSE)and bone marrow puncture results,as well as ultrasonic findings,i.e.tumor morphology,the maximum diameter,boundary,presence of liquefaction or not,encompassed large retroperitoneal blood vessels por not,spanned the midline or not,internal echoes,presence and types of calcification and Adler blood flow grades were compared between groups.Binary logistic regression analysis was performed,receiver operating characteristic curve was drawn,and the areas under the curve(AUC)were calculated.The efficacy of clinical data and ultrasonic findings for distinguishing pathological types of GNB was analyzed.Results There were significant differences of blood NSE,bone marrow puncture results,tumor calcification types and Adler blood flow grade between groups(all P<0.05).Taken pathological result as the gold standards,the AUC of single age,tumor calcification types,Alder blood flow grade and combination for the above 3 parameters for distinguishing pathological types of GNB was 0.619,0.702,0.611 and 0.864,respectively,and the latter was higher than the first three(all P<0.05).Conclusion Combination of age,tumor calcification type and Alder blood flow grade was helpful for distinguishing GNBi and GNBn in children.