超声造影联合Lemur-酪氨酸激酶3水平诊断甲状腺乳头状癌及预测其颈部淋巴结转移的价值

Value of contrast-enhanced ultrasound combined with Lemur-tyrosine kinase 3 level in diagnosing papillary thyroid carcinoma and predicting cervical lymph node metastasis

目的探讨超声造影(CEUS)联合Lemur-酪氨酸激酶3(LMTK3)水平诊断甲状腺乳头状癌(PTC)及预测其颈部淋巴结转移的价值。方法选取我院经手术病理证实的92例甲状腺结节患者,根据病理结果分为良性组42例和PTC组50例,其中PTC组根据有无颈部淋巴结转移进一步分为转移组28例和非转移组22例,术前均行甲状腺CEUS检查和LMTK3水平检测,比较良性组与PTC组、转移组与非转移组CEUS特征和LMTK3水平的差异。绘制受试者工作特征(ROC)曲线评估CEUS和LMTK3水平单独及联合应用诊断PTC及预测其颈部淋巴结转移的效能。结果PTC组CEUS等增强、低增强、非均匀增强、灌注缺损、增强时边界不清晰占比及达峰时间(TTP)、CEUS量化值、LMTK3水平均高于良性组,峰值强度(PI)低于良性组,差异均有统计学意义(均P<0.001)。转移组CEUS等增强、高增强、非均匀增强、灌注缺损、增强时边界不清晰占比及TTP、PI、CEUS量化值、LMTK3水平均高于非转移组,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,与CEUS和LMTK3水平单独应用比较,CEUS和LMTK3联合应用诊断PTC及预测其颈部淋巴结转移的准确率、灵敏度、特异度、曲线下面积分别为84.8%、86.0%、83.3%、0.835(95%可信区间:0.738~0.937)和88.0%、89.3%、86.4%、0.895(95%可信区间:0.822~0.948),与单独应用比较差异均有统计学意义(均P<0.05)。结论CEUS联合LMTK3水平在诊断PTC及预测其颈部淋巴结转移中均有较好价值,可为临床提供参考。

Objective To investigate the value of contrast-enhanced ultrasound(CEUS)combined with Lemurtyrosine kinase 3(LMTK3)level in diagnosing papillary thyroid carcinoma(PTC)and predicting cervical lymph node metastasis.Methods Retrospective analysis was made on 92 patients with thyroid nodules confirmed by surgery and pathology admitted to our hospital.According to the pathological results,the patients were divided into the benign group(42 cases)and the PTC group(50 cases).The PTC group was further divided into the metastatic group(28 cases)and the non-metastatic group(22 cases)according to the presence of cervical lymph node metastasis.The differences of CEUS characteristics and LMTK3 level between the benign group and the PTC group,the metastatic group and the non-metastatic group were compared.Receiver operating characteristic(ROC)curve was drawn to evaluate the efficacy of CEUS and LMTK3 application alone and in combination for diagnosing PTC and predicting cervical lymph node metastasis.Results In PTC group,the proportion of CEUS medium enhancement,low enhancement,non-uniform enhancement,perfusion defect,boundary unclear and time to peak(TTP),CEUS quantized value,LMTK3 level were higher than those in benign group,while peak intensity(PI)was lower than that in benign group,with statistical significance(all P<0.001).The the proportion of CEUS medium enhancement,high enhancement,nonuniform enhancement,perfusion defect,boundary unclear and TTP,PI,CEUS quantized value,LMTK3 level in metastasis group were higher than those in non-metastasis group,with statistical significance(all P<0.05).ROC curve showed that compared with CEUS and LMTK3 level application alone,the accuracy,sensitivity,specificity and area under the curve of CEUS combined with LMTK3 level in diagnosing of PTC and predicting cervical lymph node metastasis were 84.8%,86.0%,83.3%,0.835(95%confidence interval:0.738~0.937)and 88.0%,89.3%,86.4%,0.895(95%confidence interval:0.822~0.948),respectively,and the differences were statistically significant(all P<0.05).Conclusion CEUS combined with LMTK3 level has good value in diagnosing PTC and predicting cervical lymph node metastasis,and can provide clinical reference.