术前超声联合免疫组织化学预测甲状腺乳头状癌颈部中央区淋巴结转移

Preoperative ultrasound combined with immunohistochemistry for predicting cervical central lymph node metastasis of papillary thyroid carcinoma

目的观察术前超声联合免疫组织化学(免疫组化)预测甲状腺乳头状癌(PTC)颈部中央区淋巴结转移(CLNM)的价值。方法回顾性分析153例接受手术治疗的PTC患者,根据术后病理将其分为CLNM阳性组(n=75)和CLNM阴性组(n=78);比较2组患者术前超声及免疫组化检测结果,以logistic回归分析评价术前超声联合免疫组化预测颈部CLNM的价值。结果组间患者年龄、病灶最大径、微钙化、纵横比、紧邻被膜及HBME-1表达水平差异均有统计学意义(P均<0.05)。PTC患者年龄≤45岁、病灶最大径>2.0 cm、微钙化、紧邻被膜及HBMI-1(++/+++)为颈部CLNM的危险因素;据此建立的logistic模型用于预测PTC颈部CLNM的受试者工作特征(ROC)曲线下面积为0.823[95%CI(0.785,0.888)]。结论术前超声联合免疫组化可预测PTC颈部CLNM;PTC患者年龄≤45岁、病灶最大径>2.0 cm、微钙化、紧邻被膜及HBMI-1(++/+++)均为颈部CLNM的危险因素。

Objective To observe the value of preoperative ultrasound combined with immunohistochemistry for predicting cervical central lymph node metastasis(CLNM)of papillary thyroid carcinoma(PTC).Methods Data of 153 PTC patients after surgical resection were retrospectively analyzed.The patients were divided into CLNM positive group(n=75)and CLNM negative group(n=78)according to postoperative pathology.Preoperative ultrasound and immunohistochemistry were compared between groups,and logistic regression analysis was performed to explore the value of preoperative ultrasound combined with immunohistochemistry for predicting cervical CLNM of PTC.Results There were significant differences of patients'age,the maximum diameter,microcalcification,aspect ratio,being adjacent to capsule or not and HBME-1 expression of lesions between groups(all P<0.05).Patient's age≤45 years,the maximum diameter>2.0 cm,microcalcification,being adjacent to capsule and HBMI-1(++/+++)of lesion were all risk factors of cervical CLNM of PTC.A logistic model was established based on the above factors,and the area under receiver operating characteristic(ROC)curve for predicting cervical CLNM was 0.823(95%CI[0.785,0.888]).Conclusion Preoperative ultrasound combined with immunohistochemistry could be used to predict cervical CLNM of PTC.Patient's age≤45 years,the maximum diameter>2.0 cm,microcalcification,being adjacent to capsule and HBMI-1(++/+++)of lesion were all risk factors of cervical CLNM of PTC.