高频超声结合造影特征对甲状腺微小乳头状癌颈部淋巴结转移的预测价值

Value of high-frequency ultrasound combined with contrast-enhanced features in predicting cervical lymph node metastasis in thyroid micropapillary carcinoma

目的探讨高频超声及造影图像特征对甲状腺微小乳头状癌(PTMC)颈部淋巴结转移的预测作用。方法回顾性分析2015年3月至2018年12月山西医科大学第一医院经手术病理确诊的PTMC患者184例,根据是否存在淋巴结转移分为淋巴结转移PTMC组和无淋巴结转移PTMC组(简称转移组和非转移组),应用单因素分析比较两组病灶的高频超声及超声造影特征,并将单因素分析有意义的指标进行多因素回归分析,确定影响颈部淋巴结转移的独立危险因素,将这些因素联合进行综合分析,绘制受试者工作特征(ROC)曲线。结果184例患者中,50例(27.2%)发生淋巴结转移。单因素分析显示,转移组和非转移组患者年龄(χ^2=10.026)、结节的数目(χ^2=10.497)、钙化(χ^2=17.414)、纵横比(χ^2=4.564)、结节位置(χ^2=20.542)、增强时间(χ^2=7.882)、增强方式(χ^2=6.416)、增强强度(χ^2=9.899)差异均有统计学意义(均P<0.05);多因素分析显示,年龄<45岁(OR=2.626,95%CI:1.141~6.052)、多灶(OR=3.648,95%CI:1.542~8.631)、微钙化(OR=2.925,95%CI:1.055~8.115)、等/高增强(OR=8.042,95%CI:1.879~34.429)是淋巴结转移的独立危险因素(均P<0.05),四者联合ROC曲线下面积为0.762。结论高频超声及造影特征可为预测PTMC颈部淋巴结转移提供帮助,年龄<45岁、多灶、微钙化、等/高增强是PTMC患者发生淋巴结转移的独立危险因素,同时具备这4项特征,PTMC发生颈部淋巴结转移的风险明显提高。

Objective To explore the predictive value of high frequency ultrasound and contrast-enhanced imaging features in predicting cervical lymph node metastasis of papillary thyroid microcarcinoma(PTMC).Methods A retrospective analysis of 184 patients with PTMC confirmed by surgery and pathology in the First Hospital of Shanxi Medical University from March 2015 to December 2018 was performed.According to the presence or absence of lymph node metastasis,the patients were divided into metastasis group and non-metastasis group.Univariate analysis was used to compare the features of high frequency ultrasound and contrast-enhanced ultrasound in the two groups,and multivariate regression analysis was used to determine the independent risk factors of cervical lymph node metastasis,and their prediction value was analyzed with ROC curves.Results Among 184 patients,50(27.2%)had lymph node metastasis.Univariate analysis showed that age(χ^2=10.026),number of nodules(χ^2=10.497),calcification(χ^2=17.414),aspect ratio(χ^2=4.564),nodule location(χ^2=20.542),enhancement time(χ^2=7.882),enhancement mode(χ^2=6.416)and enhancement intensity(χ^2=9.899)were significantly associated with cervical lymph mode metastasis(all P<0.05).Multivariate analysis showed that age<45 years old(OR=2.626,95%CI:1.141-6.052),multifocal lesions(OR=3.648,95%CI:1.542-8.631),microcalcification(OR=2.925,95%CI:1.055-8.115)and equal/high enhancement(OR=8.042,95%CI:1.879-34.429)were independent risk factors for lymph node metastasis(P<0.05).The area under the ROC curve of above indicators combined was 0.762.Conclusions High frequency ultrasonography combined with contrast-enhanced imaging can provide useful information for predicting cervical lymph node metastasis of PTMC.For PTMC patients aged<45 years with multifocal lesions,microcalcification and equal/high enhancement,the risk of cervical lymph node metastasis is significantly increased.