常规超声征象与剪切波弹性成像在甲状腺乳头状癌被膜侵犯预测颈部淋巴结转移风险中的价值

Value of conventional ultrasound signs and shear-wave elastography in predicting the risk of cervical lymph node metastasis with capsular invasion of thyroid papillary carcinoma

目的探讨常规超声征象与剪切波弹性成像弹性比(SWE-ER)在甲状腺乳头状癌(PTC)被膜侵犯预测颈部淋巴结转移(CLNM)风险中的价值。方法收集2022年6月~2024年3月在宝鸡市人民医院经术后病理证实的PTC患者87例共93个癌结节。根据术后病理分为CLNM组和未发生CLNM组,回顾性分析甲状腺癌结节与被膜关系常规超声图像特征(癌结节与被膜接触情况、被膜连续性情况、被膜侵犯范围)及SWE-ER值,以病理诊断为金标准,绘制SWE-ER、结节与被膜关系不同界值下的ROC曲线,比较不同界值下预测颈部淋巴结转移风险的价值。利用二元Logistic回归方程计算发生CLNM患者的独立危险因素。结果发生CLNM组癌结节经线高于未发生CLNM组,差异有统计学意义(P<0.05)。发生CLNM组的被膜接触情况、被膜连续性及被膜侵犯范围占癌结节周长与未发生CLNM组相比,差异均有统计学意义(P<0.001)。发生CLNM组的SWE-ER低于未发生CLNM组,差异有统计学意义(P<0.05)。以病理为金标准,绘制不同截断值下评估CLNM风险的ROC曲线,其中以被膜侵犯范围占癌结节周长1/4为截断值的ROC曲线下面积为0.756(95%CI:0.652~0.859),诊断效能最高。二元Logistic回归多因素分析显示,甲状腺被膜中断、被膜侵犯范围占癌结节周长1/4~1/2、被膜侵犯范围占癌结节周长≥1/2均为发生CLNM的独立危险因素(P<0.05)。SWE-ER和癌结节被膜是否接触不能作为PTC发生CLNM的独立危险因素(P>0.05)。结论甲状腺癌结节与被膜的关系,尤其是对甲状腺癌结节被膜侵犯范围在超声预测CLNM中有较高诊断价值;被膜中断、被膜侵犯范围占癌结节周长1/4~1/2、被膜侵犯范围占癌结节周长≥1/2均为发生CLNM的独立危险因素,而SWE-ER和癌结节是否与被膜接触不能作为PTC发生CLNM的独立危险因素。

Objective To investigate the value of conventional ultrasound signs and shear-wave elastography elastic ratio(SWE ER)in predicting the risk of cervical lymph node metastasis(CLNM)in papillary thyroid carcinoma(PTC)invasion.Methods Eighty-seven patients with PTC confirmed by postoperative pathology from June 2022 to March 2024 in Baoji People's Hospital were collected,including 93 cancer nodules.The patients were divided into CLNM group and non-CLNM group according to postoperative pathology.The characteristics of conventional ultrasound images of the relationship between thyroid cancer nodules and the capsule(the contact between cancer nodules and the capsule,the continuity of the capsule,and the invasion range of the capsule)and the SWE-ER value were retrospectively analyzed.ROC curves of the relationship between SWE-ER,nodules and the capsule at different thresholds were drawn by pathological diagnosis as the gold standard,and the value of predicting the risk of cervical lymph node metastasis at different thresholds was compared.Independent risk factors for CLNM were calculated by binary Logistic regression equation.Results The average meridian of cancer nodules in CLNM group was higher than that in non-CLNM group(P<0.05).Compared with non-CLNM,there were statistically significant differences in capsule contact,capsule continuity and capsule invasion area in the perituberous length of cancer in CLNM group(P<0.001).The mean value of SWE-ER in the CLNM group was lower than that in the non-CLNM group(P<0.05).Using pathology as the gold standard,ROC curves were developed to assess the risk of CLNM under different cut-off values.The area under the ROC curve with the capsule invasion occupying 1/4 of the circumference of cancer nodules as cut-off value was 0.756(95%CI:0.652-0.859),indicating the highest diagnostic efficiency.Multivariate analysis by binary Logistic regression showed that thyroid capsule interruption,capsule invasion in 1/4-1/2 of the circumference of cancer nodule,capsule invasion in≥1/2 of the circumference of cancer nodule were independent risk factors for CLNM(P<0.05).The contact between SWE-ER and the capsule of cancer nodules was not an independent risk factor for CLNM of PTC(P>0.05).Conclusion The relationship between thyroid cancer nodule and capsule,especially the invasion range of thyroid cancer nodule capsule has high diagnostic value in ultrasonic prediction of CLNM.The involvement of the capsule in 1/4-1/2 of the circumference of cancer nodule,and the involvement of the capsule in≥1/2 of the circumference of cancer nodule were independent risk factors for CLNM,while SWE-ER and whether cancer nodule contacted with the capsule were not independent risk factors for CLNM in PTC.