超声造影定量分析诊断乳头状甲状腺癌患者颈部淋巴结转移的效能分析

Effectiveness of contrast-enhanced ultrasound quantitative analysis in the diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma

目的探究超声造影(CEUS)定量分析诊断乳头状甲状腺癌(PTC)患者颈部淋巴结转移的效能分析。方法回顾性分析2017年1月-2018年1月在宁波市鄞州人民医院行手术治疗的90例PTC患者,根据术后病理是否发生颈部淋巴结转移将其分为转移组(40例)和无转移组(50例),比较2组患者癌结节大小,CEUS特征(灌注强度、均匀强度、灌注缺损及灌注模式),CEUS定量参数[上升时间(RT)、峰值强度(PI)、平均渡越时间(MTT)、曲线下面积(AUC)、峰值降半时间(TPH)、上升斜率(WIS)及达峰时间(TTP)],应用ROC曲线分析CEUS相关指标取不同cut-off值的诊断价值。结果100个癌结节中76.00%(76/100)表现为低增强,89.00%(89/100)表现为灌注强度不均匀,转移组癌结节大小显著高于无转移组(P=0.002);2组患者癌结节边缘区PI、AUC和WIS显著高于中央区(均P<0.05),转移组边缘区PI、边缘区AUC显著高于无转移组(均P<0.001);ROC曲线显示,癌结节边缘AUC、边缘PI和结节大小的AUC分别为0.866、0.869和0.720,其中边缘AUC和边缘PI对颈部淋巴结转移的诊断效能均高于癌结节大小(P=0.026、0.018);Youden指数提示癌结节边缘AUC、边缘PI和结节大小位于最佳截点时,边缘AUC和边缘PI的准确率、灵敏度和阴性预测值的诊断价值显著高于结节大小(PAUC=0.042、0.001、0.019,PPI=0.018、0.003、0.022)。结论在PTC患者颈部淋巴结是否发生转移的诊断中,癌结节边缘区CEUS定量参数PI和AUC准确率和灵敏度高,具有重要的临床意义。

Objective To explore the effectiveness of contrast-enhanced ultrasound(CEUS)quantitative analysis in the diagnosis of cervical lymph node metastasis in patients with papillary thyroid cancer(PTC).Methods A retrospective analysis was made on 90 patients with PTC who underwent surgical treatment in our hospital from January 2017 to January 2018.The patients were divided into metastasis group(40 cases)and non-metastasis group(50 cases)according to whether cervical lymph node metastasis occurred after operation.The size of cancer nodules,CEUS characteristics(perfusion intensity,uniform intensity,perfusion defect and perfusion mode),CEUS quantitative parameters[rise time(RT),Peak intensity(PI),mean transit time(MTT),area under curve(AUC),peak halving time(TPH),wash in slope(WIS)and time to peak(TTP)]were compared between the two groups.The ROC curve was used to analyze the diagnostic value of CEUS related indicators for different cut-off values.Results Seventy-six percent of 100 cancer nodules showed low enhancement,89.00%showed non-uniform perfusion intensity,and the size of cancer nodules in metastatic group was significantly higher than that in non-metastatic group(P=0.002).PI,AUC and WIS in the marginal area of cancer nodules in the two groups were significantly higher than those in central area(all P<0.05),while PI,AUC in the marginal area in the metastatic group were significantly higher than those in the non-metastatic group(all P<0.001).The ROC curve showed that the edge AUC,edge PI and AUC of nodule size were 0.866,0.869 and 0.720,respectively.The diagnostic efficiency of the edge AUC and PI for cervical lymph node metastasis was higher than that of the size of the cancer nodule(P=0.026,0.018).Youden index indicated that the accuracy,sensitivity and negative predictive value of edge AUC and edge PI were significantly higher than those of nodule size at the best cut-off point(PAUC=0.042,0.001,0.019,PPI=0.018,0.003,0.022).Conclusion In the diagnosis of cervical lymph node metastasis in patients with PTC,the CEUS quantitative parameters PI and AUC in the margin of cancer nodules have high accuracy and sensitivity,which have important clinical significance.