常规超声与超声造影判断甲状腺乳头状癌被膜侵犯的应用价值

Diagnostic value of conventional ultrasound and contrast enhanced ultrasound in predicting extrathyroidal extension of papillary thyroid cancer

目的探讨常规超声及超声造影判断甲状腺乳头状癌（PTC）被膜侵犯的应用价值。方法75例患者共85个PTC结节，分别在常规超声和超声造影条件下观察癌结节与甲状腺被膜的关系，计算以不同接触范围（〉0％，≥2500，≥50％）作为被膜侵犯指标的诊断效能，并比较两种条件下诊断PTC被膜侵犯的效能差异。结果85个癌结节中，手术病理证实57个（67．06％）被膜侵犯。常规超声条件下无接触、％25％接触、25％～50％接触、≥50％接触四组中，被膜侵犯发生率依次增高，差异有统计学意义（P〈0．001）。常规超声及超声造影均显示癌结节与甲状腺被膜接触〉0％组和≥25％组的总体诊断效能相当，但接触〉0％诊断被膜侵犯的灵敏度、准确率明显高于另两组（均P〈0．001）。甲状腺被膜接触〉0％时，超声造影ROC曲线下面积明显高于常规超声（Z=2．208，P=0．027）。结论超声特征癌结节与甲状腺被膜接触范围〉0％提示PTC发生被膜侵犯有较好的灵敏度及准确率，超声造影判断被膜侵犯的能力优于常规超声，有一定的临床应用价值。

Objective To explore the diagnostic value of conventional ultrasound（US） and contrast enhanced ultrasound （CEUS） in predicting extrathyroidal extension of papillary thyroid cancer （PTC）. Methods Eighty-five PTCs in 75 patients were selected for thyroid surgery underwent ultrasound and contrast-enhanced ultrasound. The degrees of contact between PTCs and capsule were observed by US and CEUS respectively（0,0- 25 %, 25% -50%, ≥ 50%）, and the diagnostic efficiency in different degree of contact （〉0 %, ≥25%, ≥50% ） as preoperative diagnostic criteria were analyzed. The diagnostic efficiency between US and CEUS in predicting extrathyroidal extension of PTC were compared. Results Of the 85 PTCs, extrathyroidal extension was presented in 57 （67. 06% ） based on pathologic results. When the degree of contact （ 〉 0 %, 〈 25 %, 25 % - 50%, ≥ 50 % ） was gradually increased, the incidence of extrathyroidal extension of the thyroid cancer was also gradually risen （ P 〈0. 001）. Comparing the sensitivity, accuracy, odds ratio, and Az value of three groups （〉 0 %, ≥ 25 %, ≥ 50 %）, it showed that the general diagnostic efficiency between two groups（〉0%, ≥25 %） was similar by US and CEUS. However, the sensitivity and accuracy of 〉0% contact with the adjacent capsule were markedly higher than those of the other two groups（ P 〈0. 001）. Selecting 〉0% contact with the adjacent capsule as preoperative criteria, the Az value of CEUS was markedly higher than that of US （Z = 2.208, P = 0.027）. Conclusions The preoperative imaging feature of more than 0% contact with the adjacent capsule is more sensitive and accurate degree in predicting extrathyroidal extension of PTC. Compared with US, CEUS may serve as a better useful tool to predict extrathyroidal extension of PTC.