超声结合血清Tg、TSH水平对分化型甲状腺癌术前T分期和N分期的鉴别

Differentiation of ultrasound combined with serum Tg and TSH levels for preoperative T stage and N stage of differentiated thyroid cancer

目的探讨超声结合血清甲状腺球蛋白(Tg)、促甲状腺激素(TSH)水平对分化型甲状腺癌(DTC)术前T分期和N分期的鉴别价值。方法回顾性分析商丘市第四人民医院2020年6月至2022年12月收治的经病理学检查确诊的124例DTC患者的临床资料,术前均行超声检查,并检测血清Tg、TSH水平。以术后病理分期为“金标准”,评估超声检查鉴别T、N分期的准确性,比较不同T分期和N分期患者血清Tg、TSH水平;绘制受试者工作特征(ROC)曲线分析超声及血清Tg、TSH单独与联合对DTC患者术前T分期和N分期的鉴别价值。结果以术后病理为依据,超声检查T_(1)期的准确率为85.11%,T_(2)期为77.14%,T_(3)期为60.00%,T_(4)期为58.82%,N_(0)期为86.57%,N_(1)期为68.42%。T_(2)、T_(3)、T_(4)期患者的血清Tg、TSH水平均高于T_(1)期(P<0.05),T_(3)、T_(4)期患者均高于T_(2)期(P<0.05),T_(4)期患者均高于T_(3)期(P<0.05);N_(1)期患者血清Tg、TSH水平高于N_(0)期(P<0.05)。超声联合血清Tg、TSH鉴别DTC患者术前T_(1~2)与T_(3~4)分期的灵敏度、特异度、曲线下面积(AUC)分别为84.15%、97.62%、0.939,鉴别N_(0)与N_(1)分期的灵敏度、特异度、AUC分别为80.60%、96.49%、0.947,且联合鉴别T_(1~2)和T_(3~4)、N_(0)和N_(1)分期的特异度和AUC均高于单独鉴别(P<0.05)。结论超声及血清Tg、TSH均可鉴别DTC患者术前T分期和N分期,但三者联合鉴别价值更佳。

【Objective】To investigate the value of ultrasound combined with serum thyroglobulin(Tg)and thyroid stimulating hormone(TSH)levels in differentiating preoperative T stage and N stage of differentiated thyroid carcinoma(DTC).【Methods】The clinical data of 124 patients with DTC diagnosed by pathological examination in our hospital from June 2020 to December 2022 were retrospectively analyzed.Ultrasound examination was performed before operation,and serum Tg and TSH levels were also detected.The postoperative pathological stage was used as the"gold standard"to evaluate the accuracy of ultrasound examination in identifying T and N stage,and the serum Tg and TSH levels of patients with different T and N stage were compared.The receiver operating characteristic(ROC)curve was drawn to analyze the differential value of ultrasound and serum Tg,TSH alone and combined for preoperative T staging and N staging of DTC patients.【Results】Based on postoperative pathology,the accuracy of ultrasound in T_(1) phase was 85.11%,and T_(2) phase was 77.14%,and T_(3) phase was 60.00%,and T_(4) phase was 58.82%,and N_(0) phase was 86.57%,and N_(1) phase was 68.42%.The serum Tg and TSH levels of patients in T_(2),T_(3) and T_(4) stage were higher than those in T_(1) stage(P<0.05),and those in T_(3) and T_(4) stage were higher than those in T_(2) stage(P<0.05),and those in T_(4) stage were higher than those in T_(3) stage(P<0.05).The levels of serum Tg and TSH in patients with N_(1) stage were higher than those in N_(0) stage(P<0.05).The sensitivity,specificity and area under the curve(AUC)of ultrasound combined with serum Tg and TSH in differentiating preoperative T_(1~2) and T_(3~4) staging of DTC patients were 84.15%,97.62%and 0.939 respectively,and the sensitivity,specificity and AUC of differentiating N_(0) and N_(1) staging were 80.60%,96.49%and 0.947 respectively,and the specificity and AUC of combined identification of T_(1~2) and T_(3~4), N_(0) and N_(1) staging were higher than those of single identification (P<0.05). 【Conclusion】 Ultrasound, serum Tg and TSH can differentiate preoperative T stage and N stage of DTC patients, but the combination of the three has better differential value.