基于超声列线图预测甲状腺良性结节微波消融后残留

Nomogram based on ultrasound for predicting residue of benign thyroid nodules after microwave ablation

目的观察基于超声的多因素logistic回归模型列线图预测甲状腺良性结节微波消融(MWA)后残留的价值。方法回顾性纳入101例接受超声引导下MWA的甲状腺良性结节患者(共133个结节),根据MWA后1个月超声造影(CEUS)所见分为残留组(n=21)与无残留组(n=112)。比较组间MWA前甲状腺良性结节超声表现,将差异有统计学意义者纳入多因素logistic回归分析,筛选MWA后残留的独立预测因素,并绘制可视化列线图。以受试者工作特征曲线及其曲线下面积(AUC)评估列线图预测MWA后残留的区分度,以Hosmer-Lemeshow拟合优度检验评估其校准度。结果超声显示消融存在风险及结节体积均为甲状腺良性结节MWA后残留的独立预测因素(P均<0.05),提示消融风险高[OR=17.637(2.528,123.019)]及体积大的甲状腺良性结节[OR=1.297(1.155,1.457)]MWA后残留风险更高。所获列线图预测甲状腺良性结节MWA后残留的AUC为0.756,Hosmer-Lemeshow检验显示拟合度较好(P=0.401)。结论超声显示消融风险高及体积较大甲状腺良性结节MWA后残留风险较高;基于所获列线图可简便、有效地预测上述风险。

Objective To observe the value of nomogram obtained with multivariate logistic regression based on ultrasound for predicting residue of benign thyroid nodules after microwave ablation(MWA).Methods Totally 101 patients with 133 benign thyroid nodules who underwent ultrasound-guided MWA were retrospectively enrolled.The nodules were divided into residual group(n=21)and non-residual group(n=112)according to follow-up results of contrast-enhanced ultrasound(CEUS)1 month after MWA.The ultrasonic performances of nodules before MWA were compared between groups,and those being statistically different were included in a multivariate logistic regression model to identify the independent predictors for residue after MWA,and the model was then visualized as a nomogram.The discrimination of the nomogram for predicting residue after MWA was assessed with receiver operating characteristic curve and area under the curve(AUC),and its calibration was assessed with Hosmer-Lemeshow goodness-of-fit test.Results High ablation risk and nodules volume shown with ultrasound were both independent predictors of residue of benign thyroid nodules after MWA(both P<0.05),indicating that benign thyroid nodules with high ablation risk(OR=17.637[2.528,123.019])and large volume(OR=1.297[1.155,1.457])had relatively higher risk of residue after MWA.AUC of the nomogram was 0.756 for predicting residue of benign thyroid nodules after MWA,while Hosmer-Lemeshow test showed good fit(P=0.401).Conclusion Benign thyroid nodules with high ablation risk and large volume shown with ultrasound had relatively high risk of residue after MWA,which could be predicted conveniently and effectively with the obtained nomogram.