常规超声在鉴别甲状腺乳头状癌经典亚型与高细胞亚型中的应用价值

Application value of conventional ultrasound in the differentiation of classical variant and tall cell variant of papillary thyroid carcinoma

目的:对比分析经典亚型(classic variant,CV)与高细胞型(tall cell variant,TCV)甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床和常规超声特征,并构建鉴别两者的诊断模型。方法:回顾性收集2015年06月至2023年10月在西安高新医院及西安交通大学附属陕西省肿瘤医院行甲状腺超声检查并获得病理结果的PTC单发结节患者169例(CV PTC 143例,TCV PTC 26例)。比较两种亚型PTC结节的临床及超声特征差异,构建鉴别诊断两者TCV PTC的Logistic回归诊断模型并评价其模型的效能。结果:多因素二元Logistic回归分析显示,微钙化、被膜侵犯、血流丰富、肿瘤最大径>10 mm为诊断TCV PTC的独立危险因素,其对应的风险比值比分别为23.42、89.49、18.88及185.99,P值均<0.05。诊断模型受试者工作曲线下面积为0.97,鉴别诊断TCV PTC与CV PTC的灵敏度、特异度与准确性分别为100%、91.6%、92.9%。结论:常规超声在鉴别CV PTC和TCV PTC中可能具有好的临床应用价值,以常规超声特征建立的临床预测模型可能在PTC患者决策中为临床医师提供一定的指导。

Objective:To compare and analyze the clinical and conventional ultrasound features of classic variant(CV)and tall cell variant(TCV)papillary thyroid carcinoma(PTC),and to construct a diagnostic model to differentiate the two.Methods:A retrospective analysis was performed on 169 patients with single PTC nodules(CV PTC 143 cases,TCV PTC 26 cases)who underwent thyroid ultrasound examination and obtained pathological results in Xi'an Gaoxin Hospital and Shaanxi Provincial Cancer Hospital Affiliated to Xi'an Jiaotong University from June 2015 to October 2023.The differences in clinical and ultrasound features of the two subtypes of PTC nodules were compared,and the multivariate binary Logistic regression diagnostic model for differential diagnosis of TCV PTC was constructed and its model performance was evaluated.Results:Multivariate Logistic regression analysis showed that microcalcification,capsular invasion,rich blood flow,and tumor maximum diameter>10 mm were independent risk factors for the diagnosis of TCV PTC,and the corresponding hazard ratios were 23.42,89.49,18.88,and 185.99,respectively,with P values all<0.05.The area under the receiver operating characteristic curve of the diagnostic model was 0.975.The sensitivity,specificity,and accuracy of the differential diagnosis of TCV PTC and CV PTC were 100%,91.6%,and 92.9%,respectively.Conclusion:Conventional ultrasound may have good clinical application value in the differential diagnosis of CV PTC and TCV PTC.The clinical prediction model based on conventional ultrasound features may provide certain guidance for clinicians in the decision-making of PTC patients.