甲状腺微小乳头状癌超声特征与颈部淋巴结转移的相关性探讨

Correlation between ultrasonographic features of papillary thyroid microcarcinoma and cervical lymph node metastasis

目的探讨甲状腺微小乳头状癌（papillary thyroid microcarcinoma，PTMC）超声图像特征与颈部淋巴结转移的关系。方法回顾性分析在天津市肿瘤医院手术并且病理证实的PTMC575例患者，统计分析原发灶的超声特征与颈部淋巴结转移的相关危险因素。结果单因素分析显示PTMC原发灶超声征象中：直径〉5mm、纵横比≥1、多灶性、边界不清、低回声、微小钙化、结节侵及（或接触）被膜长度／结节周长≥1／4与颈部淋巴结（中央区＋侧颈区）转移相关；而当结节位于下极时，仅与中央区淋巴结转移相关。多因素分析显示微小钙化、结节侵及（或接触）被膜长度／结节周长≥1／4是颈部淋巴结（中央区＋侧颈区）转移的独立危险因素。另外，直径〉5mm、微小钙化等原发灶超声征象是侧颈淋巴结跳跃性转移的独立危险因素。结论PTMC原发灶超声征象中微小钙化、结节侵及（或接触）被膜长度／结节周长≥1／4是颈部淋巴结转移的独立危险因素。

Objective To investigate the correlation between uhrasonographic features of papillary thyroid microcarcinoma （PTMC） and cervical lymph node metastasis. Methods We reviewed 575 PTMC pathologically confirmed after operation in Tianjin Cancer Hospital, analyzing the ultrasonographic characteristics of primary site and risk factors of cervical lymph node metastasis. Results The univariate analysis showed that diameter 〉 5 mm, length over breadth ratio 〉 1, multifocality, ill-defined margin, hypoechogenicity, micro-calcification, capsule invasion 〉 1/4 perimeter of PTMC were significantly associated with cervical lymph node metastasis. Lower pole nodules were correlated with central lymph nodes metastasis. By multivariate analysis micro-calcification, capsule invasion 〉 1/4 perimeter of PTMC were independent risk factors for cervical lymph node metastasis. Diameter 〉 5 mm and micro-calcification were independent risk factors of skip metastasis of ipsilateral lymph nodes. Conclusions Micro-calcification, capsule invasion 〉 1/4 perimeter of PTMC are independent risk factors for cervical lymph node metastasis in PTMC patients.