超声造影对甲状腺乳头状癌被膜侵犯患者的诊断价值

Diagnostic value of contrast-enhanced ultrasound in patients with thyroid papillary carcinoma with membrane invasion

目的探究超声造影对甲状腺乳头状癌被膜侵犯患者的诊断价值。方法分析2015年1月～2017年2月期间接受治疗的83例甲状腺乳头状癌患者的临床资料,患者均接受常规超声检查及超声造影检查,观察并及时记录患者病灶的个数、位置等数据,观察记录癌结节与甲状腺被膜关系。采用McNemar检验比较两种方法的诊断效能。结果83例患者中侵犯组患者为51例,存在侵犯被膜或被膜外组织的癌结节的个数为76个,占比66.67%;未侵犯组患者为32例,患者未存在侵犯被膜或被膜外组织的癌结节的个数为38个,占比33.33%。侵犯组患者的肿瘤大小为(0.87±0.49)cm,未侵犯组患者的肿瘤大小为(1.27±0.78)cm,两组数据比较差异有统计学意义(t=2.265,P<0.05)。侵犯组患者存在29例颈部淋巴结转移,占比56.86%,未侵犯组患者存在17例颈部淋巴结转移,占比53.13%,两组数据差异无统计学意义(X2=1.265,P=0.156)。常规超声检查下及超声造影检查下,随着癌结节边界与甲状腺被膜的接触面积不断增加,常规超声检查的准确率、特异度、灵敏度、阴性预测值随之下降(P<0.05);A、B组患者的曲线下面积均大于C组,数据差异具有统计学意义(P<0.05)。以癌结节与甲状腺被膜接触范围>0%判断被膜侵犯,超声造影的甲状腺乳头状癌被膜侵犯患者的R0C曲线下面积与常规超声组具有统计学意义(Z=4.321,P<0.05)。结论超声造影检查甲状腺乳头状癌被膜侵犯的效用高于常规对照组,具有重要的临床推广价值。

Objective To study the diagnostic value of contrast-enhanced ultrasound in the diagnosis of papillary thyroid carcinoma. Method The clinical data of 83 patients with papillary thyroid carcinoma who were treated in our hospital from January 2015 to February 2017 were reviewed. All subjects underwent routine ultrasound and ultrasonography. The patient's lesions were observed and recorded. The relationship between cancer nodules and thyroid capsule was analyzed. McNemar test was used to compare the diagnostic efficacy of both methods. Results Of 83 patients,there were 51 patients in infringement group and 32 patients in non-invasive group. The tumor size of infringement group and non-invasive group were 0.87 ± 0.49 cm and 1.27 ± 0.78 cm ( t = 2.265, P <0.05).There were 29 cases of cervical lymph node metastasis (56.86%). There were 17 cases of cervical lymph node metastasis in the non-invasive group (53.13%). There was no significant difference between the two groups (X^2= 1.265, P = 0.156). Under normal ultrasound and ultrasound contrast examination, the accuracy, specificity, sensitivity and negative predictive value of conventional ultrasound were decreased with the increase of the contact area between the nodule and the thyroid capsule ( P <0.05). The area under the curve of group B was greater than that of group C( P <0.05). The area under the R0C curve was statistically significant ( Z = 4.321, P <0.05). The area under the R0C curve was statistically significant ( Z = 4.321, P <0.050). The area under the R0C curve of the patients with thyroid papillary carcinoma was significantly higher than that in the control group ( P <0.05). Conclusion Ultrasonography under examination of thyroid papillary carcinoma capsule invasion than the conventional control group, with important clinical value.