高频超声术前预测甲状腺乳头状癌被膜外侵犯

High-resolution ultrasound in predicting extracapsular extension of papillary thyroid cancer

目的探讨高频超声术前预测甲状腺乳头状癌(PTC)被膜外侵犯(ETE)的临床价值。方法收集经手术治疗的PTC患者116例,共151个结节,回顾性分析其声像图特点,观察结节与甲状腺被膜邻接长度占结节周长百分比(A),分析以A≥1%、A≥25%及A≥50%预测PTC ETE的诊断效能。结果 151个PTC中,手术病理证实59个(59/151,39.07%)有被膜外侵犯(ETE组),92个(92/151,60.93%)无被膜外侵犯(non-ETE组)。超声发现结节位于甲状腺实质内(A0)84个(84/151,55.63%),1%≤A<25%、25%≤A<50%、A≥50%分别有25个(25/151,16.56%)、15个(15/151,9.93%)、27个(27/151,17.88%)。A≥1%、A≥25%、A≥50%的结节个数在ETE组和non-ETE组比较差异均有统计学意义(P均<0.01)。以A=50%为截断值,诊断PTC被膜外侵犯的敏感度、特异度、准确率、阳性预测值、阴性预测值分别为37.29%(22/59)、94.57%(87/92)、72.19%(109/151)、81.48%(22/27)、70.16%(87/124)。结论高频超声可有效预测PTC有无ETE,为术前合理选择手术方式及对患者预后评估提供重要参考信息。

Objective To evaluate the clinical value of high-resolution ultrasound for predicting the extracapsular extension（ETE）of papillary thyroid cancer（PTC）.Methods A total of 151 nodules with PTC in 116 patients confirmed by surgery and pathology were enrolled.The ultrasonographic characteristics were retrospectively analyzed,and the percentage of the perimeter of the nodule that abutted the thyroid capsule（A）were observed.Taking A≥1%,A≥25% and A≥50% as cutoff value respectively,the ETE of PTC was predicted.Results Of the 151 nodules with PTC,ETE presented in 59（59/151,39.07%）,while no ETE（non-ETE）was observed in 92（92/151,60.93%）.Nodules in the thyroid parenchyma（A0）which could be observed with ultrasound was 84（84/151,55.63%）,and 1%≤A25%,25%≤A〈50%and A≥50% was 25（25/151,16.56%）,15（15/151,9.93%）,and 27（27/151,17.88%）,respectively.There were statistically significant differences of nodules between the non-ETE and ETE when A≥1%,A≥25% and A≥50%（all P〈0.01）.Taking A=50% as the cutoff value for predicting the presence of ETE,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value was 37.29%（22/59）,94.57%（87/92）,72.19%（109/151）,81.48%（22/27）and 70.16%（87/124）,respectively.Conclusion High frequency ultrasonography can effectively predict whether PTC has been invaded,which provides important reference information for preselected surgical approach and prognosis of patients.