灰阶超声联合弹性成像评估乳头状甲状腺微小癌甲状腺外浸润

Evaluation on extrathyroid extension of papillary thyroid microcarcinoma by gray-scale ultrasonography combined with elastography imaging

目的探讨灰阶超声联合弹性成像预测乳头状甲状腺微小癌(PTMC)外浸润的价值。方法回顾性分析82例共96个PTMC病灶的超声特征及相关的病理结果,超声特征包括病灶的数量、位置、最大径、内部回声、边界、弹性评分及应变率等。分析PTMC超声特征与甲状腺外浸润、中央淋巴结转移和侧方淋巴结转移的相关性。结果超声和病理测得的96个PTMC病灶最大径分别为(7.32±2.16)mm、(7.46±2.28)mm,二者差异无统计学意义(t=0.79,P>0.05)。病理T分期T1、T2、T3分别为4、16、76个,超声T分期T1、T2、T3分别为5、13、78个,二者差异无统计学差异(χ2=5.53,P>0.05)。多因素分析显示,超声T分期、甲状腺外浸润及弹性评分与甲状腺外浸润相关;中央淋巴结转移与超声诊断双侧性、侧方淋巴结转移相关;侧方淋巴结转移与超声诊断的侧方淋巴结转移相关。结论灰阶超声联合弹性成像有助于预测PTMC甲状腺外浸润。

Objective To explore the value of gray-scale ultrasound（US）combined with elastography for predicting the extrathyroidal extension in patients with papillary thyroid microcarcinoma（PTMC）.Methods The histopathologic and US,elastographic findings of 82 patients with PTMC（96lesions）were analyzed retrospectively,the gray-scale US and elastographic findings included number,location,longest dimension,echogenicity,boundary,elastic score,strain ratio and so on.The correlation between gray-scale US,elastographic findings and extrathyroidal extension,central,lateral lymph node（LN）metastasis were analyzed.Results The longest dimension of PTMC lesions on gray-scale US and histopathology was（7.32±2.16）mm and（7.46±2.28）mm,respectively,there was no statistical difference between them（t=0.79,P〉0.05）,as well as the T staging（χ^2=5.53,P〉0.05）,PTMC nodules classified as T1,T2 and T3staging on histopathology was 4,16 and 76,and on gray-scale US was 5,13 and 78,respectively.The multiple-factor analysis showed that the pathologic extrathyroidal extension was significantly associated with T staging,extrathyroidal extension and Rago score.Central LN metastasis on pathology was significantly associated with lateral LN metastasis and bilaterality on grayscale US,lateral LN metastasis on US was significantly associated with the lateral LN metastasis on pathology.Conclusion Gray-scale US combined with elastography is helpful for predicting extrathyroidal extension in PTMC patients.