超声造影和弹性成像对甲状腺微小乳头状癌中央组淋巴结转移的价值

Predictive value of contrast-enhanced ultrasound and elastography in lymph node metastasis in central group of thyroid micropapillary carcinoma

目的探讨超声造影(contrast enhanced ultrasonography,CEUS)及弹性表现对甲状腺乳头状微小癌(papillary thyroid Micro carcinoma,PTMC)中央组淋巴结(包含喉前、气管前、气管旁淋巴结)转移的价值。方法选取均行弹性成像和CEUS并经手术证实为PTMC的患者189例,回顾性分析其指标与PTMC中央组淋巴结转移的关系。结果1)单因素分析弹性评分>4分、CEUS不均匀增强、高或等增强、Peak<29.6、TP>40714是PTMC中央组淋巴结转移的危险因素(P均<0.05);2)多因素分析弹性评分>4分、CEUS呈高或等增强、Peak<29.6、TP>40714是PTMC中央组淋巴结转移的危险因素(P均<0.05)。超声弹性成像对PTMC中央组淋巴结转移的敏感度、特异度、准确度分别为70.3%、91.4%、87.3%,CEUS对PTMC中央组淋巴结转移的敏感度、特异度、准确度分别为67.6%、75.7%、74.1%,两者联合的敏感度(89.2%)、特异度(95.4%)、准确度(94.2%)均高于单独法,且差异有统计学意义(P均<0.05)。结论CEUS及弹性成像对预测PTMC中央组淋巴结转移的危险因素有一定的价值,两者联合诊断效能更高。

Objective To investigate the value of contrast enhanced ultrasonography(CEUS)and elasticity in central lymph node metastasis(including anterior laryngeal,anterior tracheal and paratracheal lymph nodes)of papillary thyroid micro carcinoma(PTMC).Methods 189 patients with PTMC confirmed by surgery and elas tography and CEUS were selected.A total of 189 patients with PTMC confirmed by pathology after surgery were selected.All the patients underwent elastography and CEUS.The relationship between the indicators and lymph node metastasis in central group of PTMC was analyzed.Results Univariate analysis showed that elasticity score>4,uneven enhancement,high or equal enhancement,Peak<29.6,TP>40714 were risk factors for lymph node metastasis in central PTMC group(P<0.05).Multivariate analysis showed that the risk factors of lymph node metastasis of PTMC were elasticity score>4,CEUS with high or equal enhancement Peak<29.6 and TP>40714(P<0.05).The sensitivity,specificity and accuracyof ultrasound elasticity for lymph node metastasis in central PTMC group were 70.3%,91.4%and 87.3%,respectively.For CEUS for lymph node metastasis in central PTMC group,those were 67.6%,75.7%and 74.1%,respectively.For the combination of the two methods,the sensitivity,specificity and accuracy of CEUS and PTMC group were 89.2%,95.4%and 94.2%,respectively,which were higher than the results of separate applications of the two methods,and the difference was statistically significant(P<0.05).Conclusion CEUS and elastography have certain value in predicting the risk factors of lymph node metastasis in central group of PTMC.The combined diagnosis of CEUS and elastography is more effective.