超声诊断甲状腺微小乳头状癌腺外侵犯的影响因素

Influencing factors of ultrasonography in the diagnosis of extraglandular invasion of thyroid micropapillary carcinoma

目的 探讨应用超声诊断甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)腺外侵犯的价值以及相关影响因素。方法 选取2021年2月至2022年12月收治的PTMC腺外侵犯患者105例(151个结节病灶)为研究对象,所有的患者均采取超声检查,以手术病理结果作为金标准。分析采取超声诊断PTMC腺外侵犯准确性,对于不同结节长径的PTMC腺外侵犯诊断情况评价,此外以超声诊断真阳性、假阴性为因变量,通过单因素与多因素Logisitc回归分析法分析超声对诊断PTMC腺外侵犯准确性的影响因素。结果 151个结节病灶中病理结果证实阳性为104例,阴性47例。超声检查阳性90例,阴性61例。超声检查真阳性81例,假阴性23例;超声检查结节长径≤5 mm病灶中阳性41例,阴性57例;结节长径>5 mm病灶中阳性26例,阴性27例;超声对结节长径>5 mm病灶的诊断敏感度高于结节长径≤5 mm病灶(P<0.05),经单因素与多因素Logistic回归分析表明结节长径≤5 mm、微钙化、结节未邻近气管、结节位于峡部均为影响超声诊断PTMC腺外侵犯准确性的独立危险因素。结论 采取超声对诊断PTMC腺外侵犯的效果好,其中对结节长径>5 mm病灶准确性高,结节长径≤5 mm、微钙化、结节未邻近气管、结节位于峡部均是影响超声诊断PTMC腺外侵犯准确性的独立危险因素,需要针对相关因素对应干预,以提高病变早期检出率,辅助疾病治疗。

Objective To investigate the value of ultrasonography in the diagnosis of extraglandular invasion of papillary thyroid microcarcinoma(PTMC)and the associated factors.Methods A total of 105 patients(151 nodal lesions)with extraglandular PTMC invasion admitted from February 2021 to December 2022 were taken for the study,all of whom were examined by ultrasound,using surgical pathology as the gold standard.The accuracy of ultrasound in the diagnosis of PTMC extraglandular invasion was analyzed,and the diagnosis of PTMC extraglandular invasion was evaluated for different nodal lengths,in addition to true positive and false negative ultrasound diagnoses as evaluation elements,and the factors influencing the accuracy of ultrasound in the diagnosis of PTMC extraglandular invasion were analyzed by single-factor and multi-factor Logisitc regression analysis.Results For the 151 nodal lesions,the pathological findings were positive in 104 cases and negative in 47 cases.Ultrasonography confirmed positive in 90 cases and negative in 61 cases.For nodule diameter≤5 mm,41 cases were confirmed positive and 57 cases were confirmed negative;for nodule diameter>5 mm,26 cases were confirmed positive and 27 cases were confirmed negative;the diagnostic sensitivity of ultrasound for nodule diameter>5 mm was higher than that for nodule diameter≤5 mm(P<0.05).Univariate and multivariate logistic regression analysis showed that nodule diameter≤5 mm,microcalcification,nodule not adjacent to the trachea,and nodule located in the isthmus were all independent risk factors for the accuracy of ultrasound diagnosis of extraglandular invasion in PTMC.Conclusion Ultrasound is effective in diagnosing extraglandular invasion of PTMC,with high accuracy for lesions>5 mm in diameter.Nodules≤5 mm in diameter,microcalcifications,nodules not adjacent to the trachea,and nodules located in the isthmus are all independent risk factors that affect the accuracy of ultrasound diagnosis of extraglandular invasion of PTMC and require intervention to improve early detection of the lesion and aid in disease management。