甲状腺结节超声要素化观测对甲状腺乳头状癌术前颈淋巴结转移风险的预测研究

Study on the prediction of cervical lymph node metastasis risk in preoperative thyroid papillary carcinoma by ultrasonic elemental observation of thyroid nodules

目的通过术前对甲状腺结节的超声要素化观测,评估单灶性甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的超声特征与颈部淋巴结转移的相关性。方法回顾性分析2017年1-12月在浙江大学医学院附属邵逸夫医院初次接受甲状腺手术且经超声及术后病理证实为单灶性PTC的患者376例,根据有无颈部淋巴结转移分为中央区及颈侧区淋巴结转移组与未转移组,分别记录四组的临床特征及超声要素化观测结果,应用χ2检验及多因素Logistic回归分析中央区淋巴结转移(central lymph node metastasis,CLNM)及颈侧区淋巴结转移(lateral lymph node metastasis,LLNM)的独立危险因素。结果多因素分析显示,癌灶后缘距甲状腺后壁包膜<0.25 cm是发生CLNM的独立危险因素(P=0.025);与癌灶体积≤0.38 cm3相比,癌灶体积>0.38 cm3(P=0.000)更易发生CLNM。多因素分析显示癌灶前缘距甲状腺前壁包膜<0.17 cm(P=0.006)、癌灶内侧缘距内侧壁包膜<0.26 cm(P=0.014)是发生LLNM的独立危险因素;与癌灶最大径≤1 cm相比,最大径>2 cm(P=0.001)更易发生LLNM;与癌灶体积≤0.38 cm3相比,癌灶体积>0.38 cm3(P=0.000)更易发生LLNM。结论单灶性PTC癌灶体积越大,距甲状腺后壁包膜越近为CLNM的独立危险因素;单灶性PTC体积越大、直径越大,距前壁包膜、内侧壁包膜越近,是发生LLNM的独立危险因素。

Objective To evaluate the correlation between ultrasound features of papillary thyroid carcinoma(PTC)and lymph node metastasis by preoperative ultrasound elemental observation of thyroid nodules.Methods Three hundred and seventy-six patients who underwent primary thyroid surgery and confirmed by ultrasound and pathological data as single-focal PTC from Jannary to December 2017 in Sir Run Run Shaw Hospital of Zhejiang Univbersity College of Medicine were retrospectively analyzed.According to the presence or absence of lymph node metastasis,they were divided into central and lateral lymph node metastasis group and non-metastasis group.Independent risk factors for central lymph node metastasis(CLNM)and lateral lymph node metastasis(LLNM)were analyzed byχ2 test and multivariate Logistic regression.Results Multivariate analysis showed that the posterior margin of the cancer was<0.25 cm from the posterior wall of the thyroid gland as an independent risk factor for CLNM(P=0.025).Compared with the tumor volume≤0.38 cm3,the cancer volume>0.38 cm3(P=0.000),was more prone to CLNM.And multivariate analysis showed that the anterior margin of the cancer was<0.17 cm(P=0.006)from the anterior thyroid capsule and the inner wall of the foci was<0.26 cm(P=0.014)as independent risk factors for LLNM.Compared with the maximum diameter of the tumor lesion≤1 cm,the maximum diameter>2 cm(P=0.001)group was more prone to LLNM.Compared with the tumor volume≤0.38 cm3,the tumor volume>0.38 cm3(P=0.000)was more prone to LLNM.Conclusions The larger volume of single focal PTC carcinoma and the closer to the posterior thyroid capsule are independent risk factors for CLNM.The larger volume and diameter of single focal PTC,and the closer to the anterior and medial wall capsule are independent risk factors for LLNM.