超声特征对超声及临床淋巴结转移阴性甲状腺微小乳头状癌颈部淋巴结转移的预测价值

Discussing the predictive value of ultrasonic characteristics in cervical lymph node metastasis of cN0-PTMC

目的探讨超声特征对术前超声及临床淋巴结转移阴性(cN0期)甲状腺微小乳头状癌(PTMC)颈部淋巴结转移的预测价值。方法入组133例cN0-PTMC,根据术后病理诊断是否有淋巴结转移,分为淋巴结转移阳性组(A组,60例)和无淋巴结转移阴性组(B组,73例)。超声特征包括结节回声、结节纵横比、结节边缘、结节边界、结节大小、结节内微钙化(数量≥5个)、结节位置、结节弹性成像、结节血流分型。采用χ^(2)检验和多因素Logistic回归分析超声特征与淋巴结转移关系,弹性成像采用t检验比较,构建弹性剪切波Emax受试者工作特征(ROC)曲线。结果结节回声、结节纵横比、结节边缘、结节边界组间差异无统计学意义(χ^(2)=0.32、0.65、0.005、0.002,P=0.571、0.421、0.941、0.883)。弹性应变率比值组间差异无统计学意义(t=0.98,P=0.333)。剪切波弹性Emax组间差异有统计学意义(t=3.56,P=0.001)。结节大小、结节内微钙化、结节位置、结节剪切波弹性Emax、结节血流分型组间差异有统计学意义(χ^(2)=6.59、11.26、7.60、10.23、14.05,P=0.010、0.001、0.006、0.001、0.003)。结节大小、结节内微钙化、结节位置、结节剪切波弹性Emax、结节血流分型经多因素Logistic回归分析,差异有统计学意义(P=0.013、0.001、0.007、0.002、0.028、0.001、0.035),有统计学意义。结论结节内微钙化(数量≥5个)、结节直径>5 mm、结节位于峡部及近包膜、结节剪切波弹性Emax≥72.5 kPa、结节呈中央型血流是预测PTMC颈部淋巴结转移的独立危险因素,对cN0-PTMC是否伴有颈部淋巴结转移具有预测价值。

Objective To investigate the predictive value of ultrasonic characteristics for cervical lymph node metastasis of papillary thyroid microcarcinoma(PTMC)in preoperative cNo stage(negative for ultrasonographic and clinical lymph node metastasis).Methods One hundred and thirty-three cases of cN0-PTMC were enrolled.According to postoperative pathological diagnosis of lymph node metastasis,they were divided into positive group with lymph node metastasis(group A,60 cases)and negative group without lymph node metastasis(group B,73 cases),Ultrasonic characteristics included nodule echo,aspect ratio,nodule margin,nodule boundary,nodule size,intra-nodule microcalcification(number of≥5),nodule location,nodule elastography,and nodule blood flow typing.Chi-square and Logistic regression were used to analyze the relationship between ultrasonic characteristics and lymph node metastasis.Elastography was compared by t-test.The ROC curve of elastic shear wave Emax was constructed.Results There were no statistically significant differences in nodule echo,aspect ratio,nodule margin and nodule boundary between groups(χ^(2)=0.32,0.650.005、0.002,P=0.571、0.4210.941、0.883).Therewasno significant differencein elastic strain rateratio between groups(t=0.98,P=0.333).There was no significant difference in elastic shear wave Emax between groups(t=3.56,P-0.001).There were statistically significant differences in nodule size,intra-nodule microcalcification,nodule location,elastic shear wave Emax and nodule blood flow classification.There were statistically significant differences in nodule size,intra-nodule microcalcification,nodule location,elastic shear wave Emax and nodule blood flow by multivariate Logistic regression analysis.Conclusion Intra-nodule microcalcification(number of≥5),nodule diameter>5 mm,nodule location in isthmus and near capsule,nodule elasticity shear wave Emax≥72.5 kPa,nodule central flow are independent risk factors for predicting cervical lymph node metastasis of PTMC,and which has predictive value for cN0-PTMC whether was accompanied by cervical lymph node metastasis.