超声及临床病理特征对甲状腺乳头状癌Delphian淋巴结转移的诊断价值

Diagnostic value of ultrasound and clinical pathological features for Delphian lymph node metastasis in patients with papillary thyroid carcinoma

目的探究超声及临床病理特征对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)Delphian淋巴结(Delphian lymph node,DLN)转移的诊断价值。方法选择2021年2月至2023年8月铜川市人民医院收治的120例PTC患者作为研究对象,其中男36例,女84例,年龄(43.69±6.85)岁。按有无DLN转移分为转移组与对照组(未转移)。两组均进行超声检查,收集其超声及临床病理特征信息,分析影响患者DLN转移的因素,并采用受试者操作特征曲线(receiver operating characteristic curve,ROC)评估超声及临床病理特征对患者DLN转移的诊断效能。采用t检验、秩和检验、χ^(2)检验。结果120例PTC患者共检出145个病灶,DLN未转移患者共93个病灶,DLN转移患者共52个病灶。转移组与对照组在年龄[>45岁:30.56%(11/36)比54.76%(46/84)]、肿瘤部位[峡部及侧叶上1/3:67.31%(35/52)比21.51%(20/93)]、纵径[≥10 mm:59.62%(31/52)比38.71%(36/93)]、纵横比[≥1:55.77%(29/52)比32.26%(36/93)]、多病灶[41.67%(21/36)比20.24%(67/84)]、被膜侵犯[63.46%(33/52)比40.86%(38/93)]、非喉前中央区淋巴结转移[53.85%(24/52)比31.18%(64/93)]方面相比,差异均有统计学意义(χ^(2)=5.921、29.718、5.864、7.639、5.917、6.818、7.180,均P<0.05)。logistic回归分析结果显示,肿瘤在峡部及侧叶上1/3、纵横比≥1、有被膜侵犯、非喉前中央区淋巴结转移为PTC患者DLN转移的危险因素(OR=3.267、7.576、3.130、8.306,均P<0.05)。ROC显示,联合诊断的曲线下面积(area under the curve,AUC)、灵敏度、特异度分别为0.775、67.31%、78.49%;肿瘤部位、纵横比、被膜侵犯及非喉前中央区淋巴结转移的AUC分别为0.729、0.618、0.613、0.613(均P<0.05)。结论PTC患者超声及临床病理特征中,肿瘤在峡部及侧叶上1/3、纵横比≥1、有被膜侵犯、非喉前中央区淋巴结转移为患者DLN转移的危险因素,且其联合具有较高的诊断价值。

Objective To explore the diagnostic value of ultrasound and clinical pathological features for Delphian lymph node(DLN)metastasis in patients with papillary thyroid carcinoma(PTC).Methods One hundred and twenty patients with PTC treated at Tongchuan People's Hospital from February 2021 to August 2023 were selected as the study objects,including 36 males and 84 females who were(43.69±6.85)years old.They were divided into a metastatic group and a control group(without metastasis)based on the presence or absence of DLN metastasis.Both groups underwent ultrasound examination.The information on their ultrasound and clinical pathological features was collected.The factors affecting DLN metastasis in the patients were analyzed.The diagnostic efficacy of ultrasound and clinical pathological features for DLN metastasis in the patients was evaluated using the receiver operating characteristic curve(ROC).t test,rank sum test,andχ^(2) test were applied.Results A total of 145 lesions were detected in the 120 patients.There were 93 lesions in the patients without DLN metastasis and 52 lesions in the patients with DLN metastasis.There statistical differences between the metastatic group and the control group in terms of age[>45 years:30.56%(11/36)vs.54.76%(46/84)],tumor location[isthmus and upper lobe 1/3:67.31%(35/52)vs.21.51%(20/93)],longitudinal diameter[≥10 mm:59.62%(31/52)vs.38.71%(36/93)],aspect ratio[≥1:55.77%(29/52)vs.32.26%(36/93)],multiple lesions[41.67%(21/36)vs.20.24%(67/84)],capsule invasion[63.46%(33/52)vs.40.86%(38/93)],and lymph node metastasis in the non-central area of the larynx[53.85%(24/52)vs.31.18%(64/93)](χ^(2)=5.921,29.718,5.864,7.639,5.917,6.818,and 7.180;all P<0.05).The results of logistic regression analysis showed that the risk factors for DLN metastasis in the patients with PTC were tumors located in the isthmus and upper one-third of the lateral lobe,aspect ratio≥1,capsule invasion,and lymph node metastasis in the non-central area of the larynx(OR=3.267,7.576,3.130,and 8.306;all P<0.05).The ROC displayed the area under the curve(AUC),sensitivity,and specificity of the combination were 0.775,67.31%,and 78.49%,respectively.The AUC's of tumor location,aspect ratio,capsule invasion,and lymph node metastasis in the non-central area of the larynx were 0.729,0.618,0.613,and 0.613(all P<0.05).Conclusions Among the ultrasound and clinical pathological features of patients with PTC,the presence of tumors in the isthmus and upper 1/3 of the lateral lobe,aspect ratio≥1,capsule invasion,and lymph node metastasis in the non-central area of the larynx are risk factors for DLN metastasis;their combination has high diagnostic value.