甲状腺乳头状癌的超声声像图特征与颈部中央区淋巴结转移的相关性研究

Correlation of ultrasonographic characteristics and cervical lymph node metastasis in papillary carcinoma of the thyroid

目的:探讨甲状腺乳头状癌(papillary carcinoma of the thyroid,PTC)的超声声像图特征与颈部中央区淋巴结转移(cervical lymph node metastasis,CLNM)的相关性。方法:回顾并分析166例经手术后病理学检查证实为PTC的患者的超声声像图,按术后病理学检查有无颈部CLNM分成转移组和非转移组。比较两组间常规超声及超声造影表现,以分析PTC超声声像图特征与CLNM的相关性。结果:单因素分析显示病灶最大径≥10 mm、形态不规则、病灶侵犯包膜(包膜中断)及病灶紧贴包膜(距包膜<1 mm)、微钙化及粗大钙化、纵横比≥1、血供丰富及超声造影达峰等或高增强的PTC在转移组的构成比明显高于非转移组(χ^(2)=25.742、22.154、61.279、6.678、4.070、4.978、22.126,P均<0.05)。多因素logistic回归分析显示病灶形态不规则、病灶与包膜的距离是CLNM的独立危险因素(P均<0.05)。结论:病灶形态不规则、病灶侵犯包膜(包膜中断)及病灶紧贴包膜(距包膜<1 mm)、血流丰富及超声造影达峰高或等增强对PTC的CLNM具有较好的预测价值,可为制订临床手术方案提供依据。

Objective:To investigate the correlation between ultrasound characteristics of papillary carcinoma of the thyroid(PTC)and cervical lymph node metastasis(CLNM).Methods:A cohort study on ultrasound features of PTC was conducted.A total of 166 pathological proven PTC patients were enrolled in this study.According to the presence or absence of CLNM,the PTC nodes were assigned into CLNM-positive group and CLNM-negative group.The differences of baseline ultrasonographic and enhancement features were performed in CLNM-positive and CLNM-negative group to analyze the correlation between PTC ultrasound characteristics and CLNM.Results:Univariate analyses showed that tumor maximum diameter≥10 mm,irregular shape,disruption of capsule or distance less than 1 mm away from thyroid capsule,microcalcification and gross calcification,aspect ratio≥1,hyperor iso-enhancement were more common in CLNM-positive group than those in CLNM-negative group(χ^(2)=25.742,22.154,61.279,6.678,4.070,4.978,22.126;all P<0.05).Multivariate analysis showed that irregular shape and distance between tumor and thyroid capsule were independent risk factors of CLNM(both P<0.05).Conclusion:Irregular shape,the disruption of capsule or distance less than 1 mm away from thyroid,hyper-vascular and hyper-or iso-enhancement are valuable ultrasonographic characteristics in predicting CLNM for PTC patients which may play a role in clinical decision.