CT平扫瘤体与甲状腺边缘接触程度对乳头状癌中央组淋巴结转移的预测

The value of CT sign “thyroid marginal contact” of papillary thyroid carcinoma to predict the cervical lymph node metastasis

目的:探讨CT平扫瘤体与甲状腺边缘接触程度对甲状腺乳头状癌(Papillary thyroid carcinoma,PTC)中央组淋巴结转移(Central lymph node metastasis,CLNM)的预测价值。方法:回顾性分析经手术和病理证实的207例单发PTC,其中CLNM阳性和阴性分别为104例和103例。根据CT征象中瘤体与甲状腺边缘接触范围的不同,将其分为<1/4组、1/4~<1/2组和≥1/2组,采用χ~2检验分析CLNM阳性和阴性在3组中的分布差异,并计算<1/4组、1/4~<1/2组、≥1/2组和1/4~<1/2组联合≥1/2组(即≥1/4组)对CLNM阳性预测的敏感度、特异度、阳性预测值、阴性预测值和准确度。结果:χ~2检验显示,CLNM阳性和阴性在<1/4组、1/4~<1/2组和≥1/2组具有统计学差异(χ~2=14.540,P<0.05),3组间进一步两两比较显示,CLNM阳性和阴性在<1/4组和1/4~<1/2组(χ~2=9.514,P<0.012 5)、<1/4组和≥1/2组(χ~2=13.715,P<0.012 5)具有统计学差异,1/4~<1/2组和≥1/2组不具有统计学差异(χ~2=0.752,P>0.012 5)。单个风险因素中,瘤体与甲状腺边缘接触范围≥1/4时的敏感度(88%)和准确度(61%)最高,与甲状腺边缘接触范围≥1/2时的特异度最高(72%)。结论:PTC与甲状腺边缘接触程度可以在很大程度上对CLNM是否阳性进行预测,当边缘接触范围≥1/4时的敏感度和准确度最高。

Objective： To investigate the value of using CT sign “thyroid marginal contact” of papillary thyroid carcinoma（PTC） to predict the central lymph node metastasis（CLNM）. Methods： This article reviewed 207 patients with surgically and pathologically verified PTC, among the patients, 104 patients with CLNM, and 103 patients without CLNM. According to the area of thyroid marginal contact, divided the patients into three groups： 〈1/4 group, 1/4-〈1/2 group and ≥1/2 group. The data was analyzed by Chi-square test, and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 〈1/4 group, 1/4-〈1/2 group,≥1/2 group and 1/4-〈1/2 group combined with ≥1/2 group（≥1/4 group） in positive CLNM were calculated. Results： The Chi-square test among multiple groups indicated that there were statistical differences between three groups in CLNM（χ2=14.540, P〈0.05）. Pairwise comparison with Chi-square test indicated that there was statistical difference between 〈1/4 group and 1/4-〈1/2 group（χ2=9.514, P〈0.012 5）, 〈1/4 group and ≥1/2 group（χ2=13.715, P〈0.012 5）, and there was no statistical difference between 1/4-〈1/2 group and ≥1/2 group（χ2=0.752, P〉0.012 5）. The sensitivity（88%） and the accuracy（61%） of ≥1/4 group were the highest; the specificity of the ≥1/2 group is the highest（72%）. Conclusion： The thyroid marginal contact can provide important evidence for the dissection of CLNM. The sensitivity and the accuracy of ≥1/4 group are the highest.