甲状腺微小乳头状癌超声特征预测颈部淋巴结转移的价值

Value of ultrasonic feature of papillary thyroid microcarcinoma in predicting cervical lymph nody metastasis

目的探讨甲状腺微小乳头状癌(PTMC)超声特征预测颈部淋巴结转移(LNM)的临床价值。方法收集2012年6月至2015年6月咸宁市第一人民医院收治的120例PTMC患者的超声影像学资料及术后淋巴结病理结果,分析其超声特征与颈部LNM的关系。结果 LNM阳性组患者肿瘤最大直径≥0.7 cm、肿瘤边界不清晰、微钙化、肿瘤突破甲状腺被膜及肿瘤位于上极的比例显著高于LNM阴性组(P<0.05)。LNM阳性组和LNM阴性组患者超声积分分别为2.54±0.48、1.42±0.13,LNM阳性组患者超声积分显著高于LNM阴性组(t=7.023,P<0.05)。经受试者工作特征曲线分析显示,以超声积分≥2.0作为临界值,其预测LNM的敏感性为87.2%,特异性为90.4%。结论PTMC超声特征可有效预测颈部LNM,当超声积分≥2.0时具有较高的诊断价值,通过建立超声积分对临床制定合理的治疗方案具有指导性作用。

Objective To investigate the clinical value of ultrasonic feature of papillary thyroid microcarcinoma（ PTMC） in predicting cervical lymph nody metastasis（ LNM）. Methods The data of ultrasonic image and lymph node pathology of 120 patients with PTMC were collected in the First People＇s Hospital of Xianning City from June 2012 to June 2015. The relationship between ultrasound features and neck LNM was analyzed. Results The rates of maximum tumor diameter ≥0. 7 cm,tumor obscure boundary,microcalcification,tumor breakthrough fibrous capsule of thyroid gland and the tumor located in the upper pole in LNM positive group were significantly higher than those in LNM negative group（ P〈0. 05）. The ultrasonic score in LNM positive group and LNM negative group was 2. 54 ± 0. 48 and 1. 42 ± 0. 13 respectively,the ultrasonic score in LNM positive group was significantly higher than that in LNM negative group（ t = 7. 023,P〈0. 05）. The receiver operating characteristic curve analysis showed that the sensitivity of predicting LNM was 87. 2%,and the specificity was 90. 4% with ultrasonic score ≥2. 0 for the critical value. Conclusions The ultrasonic feature of PTMC can significantly predict cervical LNM,it has high value in the diagnosis when ultrasonic score ≥ 2. 0. The evaluation of ultrasonic score can provide guidance to instituting clinical rational treatment.