术前超声癌灶特征预测甲状腺微小乳头状癌颈部中央区淋巴结转移的临床价值

Preoperative US features of papillary thyroid microcarcinoma predict central compartment lymph node metastases

目的 :探讨甲状腺微小乳头状癌(Papillary thyroid microcarcinoma,PTMC)术前超声癌灶特征预测颈部中央区淋巴结转移的临床价值。方法:回顾性分析2014年3月—2015年10月杭州市第一人民医院收治的182例PTMC患者的超声影像及病理资料。采用单因素和多因素Logistic回归分析术前超声癌灶特征与颈部中央区淋巴结转移的关系。结果:182例PTMC共清扫220侧中央区淋巴结,其中88侧中央区发生淋巴结转移,转移率为40.00%。单因素分析结果显示,PTMC超声癌灶特征如部位、肿瘤最大径、被膜侵犯及微钙化与其同侧中央区淋巴结转移相关(均P<0.05)。多因素Logistic回归分析进一步显示,PTMC的超声癌灶特征如部位、最大径及被膜侵犯状况与其中央区淋巴结转移密切相关(均P<0.05)。结论 :PTMC的癌灶超声特征如病灶部位、肿瘤最大径及被膜侵犯是术前预测中央区淋巴结转移的高危因素。

Objective： To evaluate the clinical significance of preoperative US features of papillary thyroid microcarcinoma （PTMC） predicting central compartment lymph node metastases （CCLNM）. Methods： The sonographic features of 182 patients with pathologically confirmed PTMC in Hangzhou First People＇s Hospital from March 2014 to October 2015 were retrospec- tively reviewed. The relationship between ultrasound characteristics of PTMC and CCLNM was analyzed by univariate analysis and logistic regression analysis. Results： The ipsilateral central lymph nodes from 220 sides were dissected in 182 cases of PTMC, of which 88 side of central lymph nodes were metastasis, so the rate of lymph node metastasis was 40%. Univariate analysis revealed that CCLNM was associated with certain preoperative US features, which included lesion location, tumor size, capsule invasion and microealcification. Moreover, Logistic regression analysis only showed that the preoperative US features of lesion location, tumor size and capsule invasion were independent factors correlated with CCLNM. Conclusions： The lesion lo- cation, tumor size and capsule invasion determined by preoperative ultrasound in PTMC are positively correlated with CCLNM.