超声造影预测被膜侵犯甲状腺乳头状癌与颈侧区淋巴结转移的临床研究

The association of extrarthyroidal extension of thyroid papillary carcinoma and lateral neck lymph node metastases with contrast enhanced ultrasound

目的探讨超声造影(CEUS)预测被膜侵犯甲状腺乳头状癌与颈侧区淋巴结转移的价值。方法回顾性分析53例于2018年1月—2021年12月在无锡市惠山区中医医院经手术病理证实为甲状腺癌被膜侵犯并行淋巴结清扫的患者,其中无淋巴结转移和仅发生中央区淋巴结转移者34例(对照组),发生颈侧区淋巴结转移伴/不伴中央区淋巴结转移者19例(病例组)。比较2组患者常规超声及CEUS特征的差异,使用受试者工作特征(ROC)曲线分析对颈侧区淋巴结转移的预测效能。结果病例组患者癌结节纵横比值≥1、CEUS表现为偏心性增强、快进快退特征比例高于对照组,差异具有统计学意义(P<0.05)。2组患者年龄、性别,超声测量结节形态、边缘、结节位置、以及血流信号在差异无统计学意义(P>0.05)。ROC曲线分析显示,联合纵横比值≥1以及CEUS偏心性增强、快进快退特征预测颈侧区淋巴结转移的AUC为0.901,敏感性为100%,特异性为86%。结论被膜侵犯的甲状腺结节伴颈侧区淋巴结转移者CEUS主要表现为偏心性增强和快进快出模式。CEUS联合结节纵横比值≥1可有效预测患者发生颈侧区淋巴结转移,有助于临床医师决策是否行颈侧区淋巴结清扫。

Objective To explore the association of extrarthyroidal extension(ETE)of papillary thyroid carcinoma and lateral neck lymph node metastases with contrast enhanced ultrasound(CEUS).Methods A total of 53 ETE patients pathologically confirmed after surgery were admitted from January 2018 to December 2021.34 patients without/with central lymph node metastasis were divided into control group,and 19 central patients with lateral lymph node metastasis with/without central lymph node metastases were divided into case group.Preoperative thyroid ultrasonography and CEUS data were retrospectively analyzed and compared between groups.ROC was plot for the predicting performance of lateral lymph node metastasis.Results The patients in case group had higher proportion of the anteroposterior diameter/transverse diameter(A/T)≥1,eccentricity enhancement,and fast-wash-in and fast-wash-out pattern than that of control group(P<0.05).There were no significant differences in patient age,gender,the shape,margin,position,and blood signal of tumors between groups(P>0.05).The ROC curve with the combination of the above factors showed good prediction performance for lateral lymph node metastasis with an AUC of 0.901,a sensitivity of 100%and a specificity of 86%.Conclusions The CEUS showed eccentricity enhancement,and fast-wash-in and fast-wash-out pattern in tumors with ETE and lateral neck lymph node metastases.When combined with A/T≥1,CEUS can be applied as a useful tool to predict lateral lymph node metastasis,which may facilitate decision making for thyroid treatment strategy of prophylactic lymphoid dissection.