术前超声评估甲状腺乳头状癌N分期及不同N分期的影响因素

Value of preoperative ultrasound in evaluating of N stage of papillary thyroid carcinoma and predictive factors of lymph node metastasis

目的探讨术前超声对人甲状腺乳头状癌N分期的评估价值及其不同N分期的相关影响因素。方法回顾性分析358例经手术及病理结果证实的乳头状癌患者的临床资料,以美国癌症联合委员会(AJCC)甲状腺癌分期系统(第8版)作为标准,将358例病例分为pN0期(无淋巴结转移)、pN1a期(中央淋巴结转移)和pN1b期(侧区淋巴结转移)。比较不同N分期患者的临床资料(性别、年龄、肿瘤大小、是否多灶、包膜外侵犯、桥本甲状腺炎、BRAF突变),并采用Kappa一致性检验分析超声评估N分期与实际病理N分期的一致性。结果 358例患者均行颈部淋巴结清扫,其中pN0期196例,pN1a期129例,pN1b期33例。术前超声评估N分期与实际病理结果分期基本一致(Kappa=0.320,P <0.01);在pN0期和pN1期(pN1a期+pN1b期)2组之间,患者的年龄、肿瘤大小及BRAF突变比较差异有统计学意义(χ^2=10.214、4.818、7.126,P均<0.05)。pN1b期与非pN1b期(pN0期+pN1期)2组之间,患者的肿瘤大小、多灶癌、包膜外侵犯比较差异有统计学意义(χ^2=19.638、14.193、9.330,P均<0.01)。结论术前超声对评估甲状腺乳头状癌N分期具有一定价值,可为临床提供诊疗支持。年龄<55岁、肿瘤> 1 cm及BRAF阳性患者更倾向于发展为pN1期;在pN1b期中,肿瘤> 1 cm、多灶癌和包膜外侵犯更为常见。

Objective To evaluate the value of preoperative ultrasound in evaluating N stage of human papillary thyroid carcinoma and its predictive factors of lymph nodes metastasis. Methods All358 patients with papillary carcinoma confirmed by surgery and pathology were retrospectively analyzed.The American Joint Committee on Cancer(AJCC) thyroid cancer staging system(8 th edition) was used as a standard, and postoperative pathological results were used as the golden criteria, 358 cases were divided into pN0 stage group(no lymph node metastasis), pN1 a stage group(central lymph node metastasis), and pN1 b stage group(lateral lymph node metastasis). The clinical predictive factors between different groups were compared(gender, age, tumor size, multifocal, extramural invasion, hashimoto thyroiditis, BRAF mutation),and the consistency of preoperative sonographic N stage and actual pathological N stage were analyzed.We try to find the capacity of the evaluation the N stage of papillary carcinoma by preoperative ultrasound examination, and the clinical predictive factors that may affect N stage. Results All 358 patients underwent cervical lymph node dissection. Results showed 196 patients in pN0 group, 129 patients in pN1 a group,and 33 patients in pN1b group. The N stage evaluated by preoperative ultrasound was basically consistent with the actual pathological N stage(Kappa=0.320, P < 0.01). Between the pN0 group and the pN1 group,the age, the tumor size and the BRAF mutuation was significantly different(χ^2=10.214, 4.818 and 7.126,P < 0.05 for all). Between the pN1 b group and the non-pN1b group(pN0 + pN1 group), tumor size,multifocality of tumor, and extrathyroid extention(ETE) were significantly different between these groups(χ^2=10.638, 14.193 and 9.330, P < 0.01 for all). Conclusion Preoperative ultrasound is useful in evaluating the N stage of thyroid papillary carcinoma, which can provide clinical support for diagnosis and treatment.Patients < 55 years of age, with tumor > 1 cm and BRAF mutation positive are more likely to develop to pN1 phase. In the pN1 b stage, tumors > 1 cm, multifocal cancer and capsular invasion are more common.