超声征象联合血清学指标预测甲状腺微小乳头状癌颈部淋巴结转移的价值

Value of ultrasonographic signs combined with serological indicators in assessing the risk of cervical lymph node metastasis from papillary thyroid microcarcinoma

目的 目前尚缺乏有效的征象或血清学指标预测甲状腺微小乳头状癌(PTMC)发生转移。文中通过分析PTMC超声征象及血清学指标,发现其中与颈中央区淋巴结转移(CLNM)相关的独立危险因素。方法 回顾性分析2020年4月至2021年5月于东部战区总医院行甲状腺手术且病理证实为PTMC的患者164例,其中左叶74枚、右叶90枚。按有无CLNM将患者分为阳性组及阴性组,应用单因素及二元Logistic回归分析2组患者血清学指标及病灶超声特征,以确定影响CLNM的独立危险因素,并采用ROC曲线对独立危险因素预测颈部淋巴结转移的价值进行评估比较。结果 164例患者中,61(37.2%)例表现为CLNM阳性。单因素分析显示,CLNM情况在不同年龄、肿瘤最大径、形状、微钙化、TSH和TG-Ab水平升高患者间差异有统计学意义(P<0.05)。多因素分析显示,年龄<39岁、微钙化、TSH为CLNM的独立危险因素。微钙化与TSH联合预测CLMN的敏感度、特异度、AUC分别为73.77%、65.05%、0.702。结论 PTMC超声学特征中的形状、微钙化灶及血清学TSH、TG-Ab的升高与其CLNM具有一定的相关性。超声指标联合血清TSH检测在PTMC的CLNM预测中有重要的临床价值。

Objective At present, there are no effective signs or serological indicators to predict the metastasis of papillary thyroid microcarcinoma(PTMC). In this paper, the independent risk factors associated with central cervical lymph node metastasis(CLNM) were identified by analyzing the ultrasonographic signs and serological indicators of PTMC. Methods A total of 164 patients who underwent thyroid surgery and pathologically confirmed PTMC in the General Hospital of Eastern Theater Command from April 2020 to May 2021 were retrospectively analyzed, including 74 cases of left lobe and 90 right lobe. The patients were divided into positive group and negative group according to the presence of CLNM. Univariate and binary Logistic regression analysis were used to analyze the serological indexes and ultrasound characteristics of lesions in the two groups to determine the independent risk factors for CLNM. ROC curve was used to evaluate and compare the value of independent risk factors in predicting cervical lymph node metastasis.Results Among 164 patients, 61(37.2%) were CLNM positive. Univariate analysis showed that there were significant differences in CLNM among patients with different ages, tumor maximum diameter, shape, microcalcification, elevated TSH and TG-AB levels(P<0.05). Multivariate analysis showed that age<39 years, microcalcification and TSH were independent risk factors for CLNM. The sensitivity, specificity and AUC of microcalcification combined with TSH in predicting CLMN were 73.77%, 65.05% and 0.702, respectively.Conclusion The shape of PTMC ultrasound features, microcalcification foci, and the elevation of TSH and TG-AB in serum were correlated with CLNM to some extent. Ultrasound index combined with serum TSH detection has important clinical value in predicting CLNM of PTMC.