CT对甲状腺乳头状癌被膜侵犯及颈部淋巴结转移的预测价值

Role of CT in predicting capsular invasion and cervical lymph node metastasis in papillary thyroid carcinoma

目的探讨CT瘤体-甲状腺边缘接触范围(MCR)对长径>1.0 cm的甲状腺乳头状癌(PTC)和≤1.0 cm甲状腺微小乳头状癌(PTMC)被膜侵犯及颈部淋巴结转移的预测价值,并评估CT直接征象对颈部淋巴结转移的诊断效能。方法回顾性分析2017年1月至2020年4月杭州市第一人民医院经手术病理证实的148例PTC(>1.0 cm)和193例PTMC患者的CT资料。基于CT平扫图像评价MCR,分为<1/4瘤体周长或≥1/4瘤体周长。观察颈部淋巴结CT直接征象包括囊变、微钙化、高强化、短径/长径≥0.5、簇状淋巴结或中央区混浊。MCR在PTC(>1.0 cm)和PTMC中分布的差异比较采用χ^(2)检验,并以病理结果为金标准,计算MCR、CT直接征象诊断被膜侵犯和淋巴结转移的诊断效能。结果148例PTC(>1.0 cm)和193例PTMC中,病理结果显示被膜侵犯分别占88.5%(131/148)和57.0%(110/193),淋巴结转移分别占71.6%(106/148)和44.0%(85/193)。PTC(>1.0 cm)中,MCR≥1/4瘤体周长更常见于被膜侵犯(χ^(2)=22.211,P<0.001)和淋巴结转移患者(χ^(2)=4.746,P=0.029),其预测被膜侵犯和淋巴结转移的灵敏度和特异度分别为84.7%(111/131)和64.7%(11/17)、83.0%(88/106)和33.3%(14/42)。PTMC中,MCR≥1/4瘤体周长更常见于被膜侵犯(χ^(2)=66.066,P<0.001)和淋巴结转移患者(χ^(2)=5.343,P=0.021),其预测被膜侵犯和淋巴结转移的灵敏度和特异度分别为87.3%(96/110)和69.9%(58/83)、71.8%(61/85)和44.4%(48/108)。CT直接征象对PTC(>1.0 cm)、PTMC诊断淋巴结转移灵敏度和特异度分别为89.6%和73.8%、69.4%和76.9%。结论CT直接征象和MCR≥1/4瘤体周长均可预测PTC颈部淋巴结转移,前者具有更高的灵敏度和特异度。MCR≥1/4瘤体周长预测PTC被膜侵犯具有较高的效能。

Objective To investigate the value of CT tumor-thyroid marginal contact range(MCR)for predicting capsular invasion and cervical lymph node metastasis in papillary thyroid carcinoma(PTC)with a diameter>1.0 cm and papillary thyroid microcarcinomas(PTMC)with a diameter≤1.0 cm,and to evaluate the diagnostic efficacy of direct CT signs for lymph node metastasis.Methods The CT data of 148 patients with PTC(>1.0 cm)and 193 patients with PTMC confirmed by surgery and pathology were retrospectively analyzed from January 2017 to April 2020 at Hangzhou First People′s Hospital.MCR was evaluated based on CT images and classified as<1/4 tumor circumference or≥1/4 tumor circumference.Direct CT signs of cervical lymph nodes were observed,including cystic change,microcalcification,hyperenhancement,short/long diameter≥0.5,clustered lymph nodes or central area turbidity.The difference in the distribution of MCR between PTC(>1.0 cm)and PTMC was compared using the χ^(2) test,and the efficiency of MCR and direct CT signs for diagnosing capsular invasion and lymph node metastasis was calculated using the pathological results as the gold standard.Results In 148 PTC(>1.0 cm)and 193 PTMC patients,the pathological results showed capsular invasion in 88.5%(131/148)and 57.0%(110/193),and lymph node metastasis in 71.6%(106/148)and 44.0%(85/193),respectively.In PTC(>1.0 cm)patients,MCR≥1/4 tumor circumference was more common in patients with capsular invasion(χ^(2)=22.211,P<0.001)and lymph node metastasis(χ^(2)=4.746,P=0.029),and the corresponding sensitivity and specificity for predicting capsular invasion and lymph node metastasis were 84.7%(111/131)and 64.7%(11/17),83.0%(88/106)and 33.3%(14/42),respectively.In PTMC patients,MCR≥1/4 tumor circumference was more common in patients with capsular invasion(χ^(2)=66.066,P<0.001)and lymph node metastasis(X^(2)=5.343,P=0.021),and its sensitivity and specificity for predicting capsular invasion and lymph node metastasis were 87.3%(96/110)and 69.9%(58/83),71.8%(61/85)and 44.4%(48/108),respectively.The sensitivity and specificity of direct CT signs for diagnosing lymph node metastasis in PTC(>1.0 cm)and PTMC were 89.6%and 73.8%,69.4%and 76.9%,respectively.Conclusions Both direct CT signs and MCR≥1/4 tumor circumference can predict cervical lymph node metastasis in PTC patients,and the former had higher sensitivity and specificity.MCR≥1/4 tumor circumference has high efficiency for predicting capsular invasion in PTC patients.