术前超声联合降钙素水平预测甲状腺髓样癌颈侧区淋巴结转移

Preoperative ultrasonography combined with calcitonin level for predicting lateral cervical lymph node metastasis of medullary thyroid carcinoma

目的 观察术前超声联合血清降钙素(Ctn)水平预测甲状腺髓样癌(MTC)颈侧区淋巴结转移的价值。方法 回顾性分析46例接受甲状腺全切+颈部淋巴结清扫术的MTC患者,根据术后病理显示颈侧区淋巴结转移与否分为转移组(n=24)和非转移组(n=22);对比2组术前超声特征及Ctn水平,将组间差异有统计学意义的因素纳入logistic回归分析,观察各因素及联合模型预测颈侧区淋巴结转移的价值。结果 转移组超声显示甲状腺结节最大径≥1.5 cm、近包膜、边缘不规整、内部存在钙化、颈部可疑淋巴结及术前Ctn高水平占比均高于未转移组(P均<0.05);甲状腺结节近包膜、边缘不规整及术前Ctn高水平是MTC发生颈侧区淋巴结转移的独立危险因素(P均<0.05),其预测转移的曲线下面积(AUC)分别为0.767、0.621及0.708;依据以上因素构建的联合模型预测转移的AUC为0.887,大于各单一因素模型(P均<0.05)。结论 术前超声显示甲状腺结节近包膜及边缘不规整,结合术前Ctn高水平,可有效预测MTC颈侧区淋巴结转移。

Objective To observe the value of preoperative ultrasonography combined with calcitonin(Ctn) level for predicting lateral cervical lymph node metastasis of medullary thyroid carcinoma(MTC). Methods Data of 46 MTC patients who underwent total thyroidectomy and cervical lymph node dissection were retrospectively analyzed. The patients were divided into metastatic group(n=24) and non-metastatic group(n=22) according to postoperative pathological findings of whether cervical lymph node metastasis or not. The preoperative ultrasonic characteristics of MTC nodules and Ctn levels were compared between groups, and the factors being significant difference between groups were included in logistic regression analysis. The value of models of each factor and combination of the above factors for predicting lateral cervical lymph node metastasis were observed. Results The ratio of the maximum diameter of nodule ≥1.5 cm, nodule near thyroid capsule with irregular edge and internal calcification and suspicious malignant cervical lymph nodes on ultrasonography as well as high preoperative Ctn level in metastasis group were higher than those in non-metastasis group(all P<0.05). Nodules near thyroid capsule, with irregular edge and high preoperative Ctn level were independent risk factors of lateral cervical lymph node metastasis of MTC(all P<0.05), and the area under the curve(AUC) was 0.767, 0.621 and 0.708, respectively, while the AUC of the combining model of above factors was 0.887, higher than that of each single factor model(all P<0.05). Conclusion Nodules near thyroid capsule with irregular edge on preoperative ultrasonography and high preoperative Ctn level could be used for predicting lateral cervical lymph node metastasis of MTC.