多模态超声对甲状腺乳头状癌腺外侵犯及颈部中央区淋巴结转移的预测价值

Value of conventional ultrasound combined with shear-wave elastography in prediction of extradenocarcinoma of thyroid papillary carcinoma and lymph node metastasis in the central region of neck

目的研究多模态超声特征及参数对甲状腺乳头状癌(Papillary thyroid carcinoma,PTC)腺外侵犯及颈部中央区淋巴结转移的预测价值。方法以2022年1月-2024年1月在首都医科大学大兴教学医院行颈部中央区淋巴结清扫的120例PTC患者为研究对象。采用HI VISION Preirus彩色多普勒超声诊断仪对所有PTC患者进行影像学检查,记录患者的肿瘤最大径、边界、纵横列比及微钙化、剪切波弹性成像杨氏模量最大值(Emax)、标准差(Standard deviation,SD)。查阅患者病历系统,收集所有患者的性别、年龄、肿瘤家族史和结节部位。通过术中或术后镜下病理结果评估有无PTC腺外侵犯及颈部中央区淋巴结转移情况。结果120例PTC患者中,发生腺外侵犯者48例,无腺外侵犯者72例;发生淋巴结转移者43例,无淋巴结转移者77例。PTC有、无腺外侵犯及有、无淋巴结转移患者的性别、年龄、肿瘤家族史和结节部位比较,差异均无统计学意义的(P>0.05)。与无腺外侵犯患者比较,有腺外侵犯患者的结节最大径、Emax和SD显著增大,差异有统计学意义(P<0.05)。与无淋巴结转移患者比较,有淋巴结转移患者结节最大径和SD显著增大,微钙化的比例显著增高,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果表明结节最大径及弹性成像SD是PTC腺外侵犯的独立危险因素(P<0.05),微钙化及弹性成像SD是PTC淋巴结转移的独立危险因素(P<0.05)。ROC曲线分析结果显示,结节最大径及弹性成像SD预测PTC腺外侵犯的AUC为0.828(95%CI=0.756~0.901),灵敏度和特异度分别为70.8%和77.8%。微钙化及弹性成像SD预测PTC淋巴结转移的AUC为0.844(95%CI=0.769~0.919),灵敏度和特异度分别为72.9%和88.9%。结论多模态超声特征及参数对甲状腺乳头状癌腺外侵犯及颈部中央区淋巴结转移具有较好的诊断价值。

ObjectiveTo investigate the value of multimodal ultrasonography in the prediction of extragadenial invasion and lymph node metastasis of papillary thyroid carcinoma(PTC).Methods120 patients with PTC who underwent lymph node dissection in central region of neck in the hospitalfrom January 2022 to January 2024 were studied.Imaging examinations were performed on all PTC patients with HI VISION Preirus color Doppler ultrasound,and the maximum diameter,boundary,horizontal and horizontal column ratio,micro-calcification,maximum Young′s modulus(Emax)and standard deviation(Esd)of shear wave elastic imaging were recorded.The patient record system was consulted to collect gender,age,tumor family history and nodule site of all patients.Intraoperative or postoperative pathological findings were used to evaluate the presence or absence of PTC extrandular invasion.Lymph node metastasis in the central region of the neck was determined by postoperative pathology.ResultsOf the 120 PTC patients,48 cases had extraducular invasion and 72 cases had no extraducular invasion.There were 43 cases with lymph node metastasis and 77 cases without lymph node metastasis.There were no significant differences in gender,age,family history of tumor,and nodule location in patients with or without extrandular invasion of PTC and with or without lymph node metastasis(P>0.05).Compared with the patients without extrandular invasion,the maximum diameter of nodules in patients with extrandular invasion was significantly increased,and Emax and Esd were significantly increased,with statistical significance(P<0.05).Compared with patients without lymph node metastasis,the maximum diameter of nodules,the proportion of microcalcification and Esd were significantly increased in patients with lymph node metastasis,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that maximum nodule diameter and elastic imaging Esd were independent risk factors for PTC extrandular invasion(P<0.05),and microcalcification and elastic imaging Esd were independent risk factors for lymph node metastasis of PTC(P<0.05).ROC curve analysis showed that the AUC of the maximum nodule diameter and elastic imaging Esd to predict the extrandular invasion of PTC was 0.828(95%CI=0.756~0.901),and the sensitivity and specificity were 70.8%and 77.8%,respectively.The AUC of microcalcification and elastic imaging Esd for predicting PTC lymph node metastasis was 0.844(95%CI=0.769~0.919),and the sensitivity and specificity were 72.9%and 88.9%,respectively.ConclusionThe characteristics and parameters of multimodal ultrasonography are valuable in the diagnosis of extradenocarcinoma of thyroid papillary carcinoma and lymph node metastasis in the central region of neck.