术前CT双能量成像联合血清甲状腺球蛋白水平对甲状腺乳头状癌颈部淋巴结转移的诊断价值

Diagnostic value of preoperative dual-energy CT imaging combined with serum thyroglobulin level in cervical lymph node metastasis of thyroid papillary carcinoma

目的:探讨术前CT双能量成像联合血清甲状腺球蛋白(thyroglobulin,Tg)对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)颈部淋巴结转移(cervical lymph node metastasis,CLNM)的诊断价值。方法:回顾性分析2019年5月至2021年10月在合肥京东方医院完成甲状腺癌根治术治疗的81例PTC患者的相关资料,患者术前均接受CT双能量成像扫描检查和血清Tg水平检测。以手术病理结果为金标准,将81例PTC患者按是否发生过CLNM分别分为CLNM组(n=34)和非颈部淋巴结转移组(non-cervical lymph node metastasis,N-CLNM;n=47)。比较两组术前Tg水平和CT双能量成像检查资料。采用受试者工作特征(receiver operator characteristic,ROC)曲线评价术前血清Tg水平、术前CT双能量成像检查以及联合诊断对PTC患者CLNM的诊断价值。结果:CLNM组术前血清Tg水平为97.85(75.01,117.51) ng/mL,明显高于N-CLNM组的71.30(41.79,92.34) ng/mL,2组比较有统计学意义(P<0.001)。CLNM组淋巴结短径长于N-CLNM组,CLNM组淋巴结短径>10 mm、钙化征、明显强化、囊性或坏死、侵犯周围组织的比例均高于N-CLNM组(均P<0.05)。ROC曲线显示:术前血清Tg水平联合术前CT双能量成像征象诊断PTC患者CLNM的曲线下面积为0.832(95%CI:0.763~0.901),灵敏度为82.41%,特异度为100.00%,均高于术前血清Tg水平、术前CT双能量成像征象单一诊断。结论:PTC患者术前血清Tg水平和CT双能量成像形态学征象均与CLNM的发生紧密相关,二者联合应用可为术前CLNM的诊断提供依据。

Objective: To investigate the value of preoperative dual-energy CT combined with serum thyroglobulin(Tg) in the diagnosis of cervical lymph node metastasis(CLNM) of thyroid papillary carcinoma(PTC).Methods: The data of 81 patients with PTC who completed radical thyroidectomy in Hefei BOE Hospital from May 2019 to October 2021 were analyzed retrospectively. All patients underwent dual-energy CT scanning and serum Tg level detection before operation. Taking the surgical and pathological results as the gold standard, 81 patients with PTC were divided into a CLNM group(34 patients with CLNM) and a N-CLNM group(47 patients without CLNM). The preoperative Tg levels and dual-energy CT examination data of the 2groups were compared. The receiver operator characteristic(ROC) curve was used to evaluate the diagnostic value of preoperative serum Tg level, preoperative dual-energy CT examination and combined diagnosis for CLNM in PTC patients.Results: The preoperative serum Tg level of the CLNM group was 97.85(75.01,117.51) ng/mL, which was significantly higher than that of the N-CLNM group [71.30(41.79,92.34) ng/mL], the difference was statistically significant(P<0.001). The short diameter of lymph nodes in the CLNM group was longer than that in the N-CLNM group, and the proportions of short diameter >10 mm, calcification, obvious enhancement, cystic or necrosis and invasion of surrounding tissues in the CLNM group were higher than those in the N-CLNM group(all P<0.05). ROC curve showed that the area under the curve of preoperative serum Tg level combined with preoperative dual-energy CT features in diagnosing CLNM in PTC patients was 0.832, 95% confidence interval was 0.763 to 0.901,the sensitivity was 82.41%, and the specificity was 100.00%, which were all higher than those of preoperative serum Tg level and preoperative dual-energy CT features alone.Conclusion: The preoperative serum Tg level and dual-energy CT morphological features of PTC patients are closely related to the occurrence of CLNM. The combined application of the serum Tg level and dual-energy CT features can provide a basis for the diagnosis of CLNM before operation.