甲状腺乳头状癌超声征象与颈侧区淋巴结转移的相关因素分析

Correlation between ultrasonic features of papillary thyroid carcinoma and lateral lymph node metastasis

目的分析甲状腺乳头状癌患者颈侧区淋巴结转移的相关危险因子。方法收集我院接受手术治疗的甲状腺乳头状癌患者208例,单因素及多因素回归分析甲状腺乳头状癌患者中央区淋巴结转移(X1)、肿瘤与甲状腺被膜关系(X2)、双侧(X3)、最大径(X4)、多发性(X5)、钙化(X6)、位置(X7)、肿瘤边缘及内部均可见丰富血流信号(X8)、患者年龄(X9)及性别(X10)与颈侧区淋巴结转移间的关系。结果筛选出颈侧区淋巴结转移的危险因子:中央区淋巴结转移(X1)、肿瘤与甲状腺被膜关系(X2)、多发性(X5)、位置(X7)、肿瘤边缘及内部均可见丰富血流信号(X8);建立回归方程:Logistic(P)=-6.169+3.901X1+0.952X2+1.173X5+1.478X7+1.593X8。当预测概率≥0.33时,诊断颈侧区淋巴结转移的敏感性、特异性分别为92.3%、79.9%,曲线下面积为0.923;当中央区淋巴结转移数≥3枚时,诊断颈侧区淋巴结转移的敏感性、特异性分别为79.7%、91.6%,曲线下面积为0.915;当中央区淋巴结转移率≥37%时,诊断颈侧区淋巴结转移的敏感性、特异性分别为87.1%、79.0%,曲线下面积为0.882。结论术前超声检查可预评估甲状腺乳头状癌患者颈侧区淋巴结转移的发生风险,对指导临床治疗具有重要意义。

Objective To analyze the risk factors of lateral lymph node metastasis（LLNM）in patients with papillary thyroid carcinoma.Methods Two hundred and eight patients with papillary thyroid carcinoma received surgery in our hospital were collected.Parameters including central lymph node metastasis（CLNM,X1）,relationship between tumor and thyroid capsule（X2）,bilateral occurrence（X3）,maximum diameter（X4）,multiple lesions（X5）,calcification（X6）,position（X7）,rich blood flow signals in tumor margin and internal（X8）,age（X9）,and sex（X10）.The correlation between these parameters and LLNM were analyzed.Results The risk factors of LLNM was screened out,X1,X2,X5,X7 and X8 were the risk factors for LLNM in patients with papillary thyroid carcinoma.The regression equation：Logistic（P）=-6.169＋3.901 X1＋0.952 X2＋1.173 X5＋1.478 X7＋1.593 X8.Taking the predicted probability≥0.33,the diagnostic sensitivity,specificity and the area under curve（AUC）of LLNM were 92.2%,79.7% and 0.923,respectively.Taking the number of CLNM ≥3,the diagnostic sensitivity,specificity and AUC of LLNM were79.7%,91.6% and 0.915,respectively.When the rate of centre lymph node metastasis≥37%,the diagnosis sensitivity,specificity and AUC were 87.5%,79.0% and 0.882,respectively.Conclusion Preoperative assessment of the risk of LLNM in patients with papillary thyroid carcinoma by ultrasound has great significance to guide the clinical decision.