甲状腺乳头状癌淋巴结外软组织阳性的临床病理特征及超声表现

Clinicopathological and ultrasound characteristics of extranodal extension in metastatic papillary thyroid carcinoma patients

目的探讨甲状腺乳头状癌淋巴结外软组织阳性患者的临床病理特征及超声表现。方法收集2011年3月至2016年3月行手术且病理确诊为甲状腺乳头状癌患者的临床资料，其中伴区域淋巴结转移和淋巴结外软组织阳性的患者59例（软组织阳性组）。选取仅有区域淋巴结转移而不伴淋巴结外软组织阳性的患者作为软组织阴性组（117例）。比较软组织阳性组和软组织阴性组患者的临床病理特征及术前超声表现。结果软组织阳性患者59例，年龄〈45岁36例，年龄≥45岁23例。59例软组织阳性组患者中，仅出现单个淋巴结外软组织阳性40例，多个淋巴结外软组织阳性19例；其中Ⅵ区最常出现淋巴结外软组织阳性（32例），其次为Ⅲ区（25例）、Ⅳ区（16例）和Ⅱ区（11例）。在软组织阳性组患者的转移淋巴结超声征象中，融合征、微小钙化、囊性区和淋巴结长短径之比〈2的发生率分别为13．6％（8／59）、66．1％（39／59）、28．8％（17／59）和88．1％（52／59），软组织阴性组分别为3．4％（4／117）、46．2％（54／117）、12．8％（15／117）和75．2％（88／117），差异均有统计学意义（均P〈O．05）。软组织阳性组和软组织阴性组患者转移性淋巴结的最大径分别为（1．95±1．01）cm和（1．63±0．94）cm，差异有统计学意义（P=0．028）。logistic多因素分析显示，融合征和囊性区是甲状腺乳头状癌淋巴结外软组织阳性的独立影响因素（均P〈O．05）。结论超声检查示甲状腺癌可疑转移性肿大淋巴结，伴有融合征、微小钙化、囊性区和淋巴结长短径之比〈2为淋巴结外软组织受累的影响因素，其中融合征和囊性区与软组织阳性密切相关，为术前超声检查明确转移性淋巴结是否伴有淋巴结外软组织阳性提供有力证据。

Objective To explore clinicopathological and ultrasound characteristics of extranodal extension in metastatic papillary thyroid carcinoma patients. Methods 176 patients with papillary thyroid carcinoma who were diagnosed in Tianjin Medical University Cancer Institute and Hospital between March 2011 and March 2016 were identified and recruited in the study. Among the 176 patients, 59 patients were diagnosed with regional lymph nodes metastasis accompanied with extranodal extension （extranodal extension positive group） , 117 patients were regional lymph nodes metastasis without extranodal extension （extranodal extension negative group ）. The clinieopathological and ultrasound characteristics between extranodal extension positive group and extranodal extension negative group were also discussed in this article. Results 59 patients were diagnosed with regional lymph nodes metastasis accompanied with extranodal extension （ extranodal extension positive group）. Single lymph node region of extranodal extension was identified in 40 patients, while 19 patients were confirmed with more than 2 regions of extranodal extension. The most frequent extranodal extension were detected in region VI lymph nodes （32 cases ）, following by Ⅲ （25 cases）, Ⅳ （16 cases）, Ⅱ （11 cases）. In the aspect of ultrasound characteristics, metastatic papillary thyroid carcinoma with extranodal extension showed a higher incidence of node matting [ 13.6% （8/59） vs 3.4% （4/117）, P = 0.022 ], micro-calcification [ 66.1% （39/59） vs 46.2% （ 54/117 ）, P = 0.016 ], cystic [28.8%（17/59） vs 12.8% （ 15/117）, P= 0.013], aspect ratio （L/S） 〈2[ 88.1% （52/59） vs 75.2% （88/117）, P= 0. 032 ] and larger diameter （ 1.95 ± 1.01 cm vs 1.63 ±0.94 cm, P = 0.028 ）. Logistic multivariate analysis demonstrated that node matting （ P = 0.025） and cystic （ P = 0.026） were independent risk factors for extranodal extension. Conclusion Node matting, micro-calcification, cystic, aspect（L/T）〉2 and larger diameter were associated with extranodal extension in metastatic papillary thyroid carcinoma patients, especially node matting and cystic, which might help topre-operative ultrasound diagnosis of cxtranodal extension.