甲状腺微小乳头状癌颈部淋巴结转移的超声诊断效能及影响因素分析

Analysis of the diagnostic efficacy and influencing factors of ultrasound in cervical lymph node metastasis in papillary thyroid microcarcinoma

目的探讨甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)颈部淋巴结转移(lymph node metastasis,LNM)的超声诊断效能及影响因素分析。方法回顾性分析2020年11月至2022年10月赣州市妇幼保健院收治的86例PTMC患者的临床资料。患者均于术前开展超声检查,并行颈部中央区淋巴结清扫术,以病理检查结果为金标准,比较超声检查对PTMC患者LNM的检出率,比较LNM和未转移患者超声参数,采用Logistic回归分析方法分析影响PTMC患者发生LNM的因素,建立风险评估模型,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)评估模型诊断效能。结果病理检查和超声检查LNM检出率比较差异无统计学意义。LNM与未转移患者病灶纵横比、边界、内部有无钙化、钙化大小、结节侵及长度/结节周长比较差异有统计学意义(P<0.05);LNM与未转移患者病灶形态、位置回声类型、回声均匀性、后方回声比较差异无统计学意义。Logistic回归模型多因素分析结果显示,病灶边界不清、微小钙化、结节侵及长度/结节周长≥1/4是PTMC患者发生LNM的独立危险因素(OR>1,P<0.05)。ROC曲线分析结果显示,病灶边界不清、微小钙化、结节侵及长度/结节周长联合检测的曲线下面积最高,为0.909,灵敏度、特异度分别90.47%、80.95%。结论超声检查对PTMC患者LNM具有一定的诊断价值,其中病灶边界不清、微小钙化、结节侵及长度/结节周长≥1/4是PTMC患者发生LNM的独立危险因素,应有效控制相关危险因素,以降低PTMC患者发生LNM的风险。

Objective To investigate the diagnostic efficacy and influencing factors of ultrasound in cervical lymph node metastasis(LNM)of papillary thyroid microcarcinoma(PTMC).Methods The clinical data of 86 patients with PTMC admitted to Ganzhou Maternal and Child Health Hospital from November 2020 to October 2022 were retrospectively analyzed.All patients underwent ultrasound examination and central neck lymph node dissection,the results of pathological examination were used as the gold standard to compare the detection rate of LNM in PTMC patients by ultrasound examination,the ultrasound parameters of LNM and non-metastatic patients were compared,Logistic regression analysis was used to analyze the factors affecting LNM in PTMC patients,the risk assessment model was established and the receiver operating characteristic curve(ROC curve)was drawn to evaluate the diagnostic efficacy of the model.Results There was no significant difference in the detection rate of LNM between pathological examination and ultrasound examination.There were significant differences in lesion aspect ratio,boundary,internal calcification,calcification size,nodule invasion length/nodule circumference between LNM and non-metastatic patients(P<0.05);there was no significant difference in lesion morphology,location echo type,echo uniformity and posterior echo between LNM and non-metastatic patients.Multivariate analysis of Logistic regression model showed that lesion unclear boundary,microcalcification,nodule invasion length/nodule circumference≥1/4 were independent risk factors for LNM in PTMC patients(OR>1,P<0.05).The results of ROC curve analysis showed that the area under the cure of combined detection of unclear boundary,microcalcification,nodule invasion and length/nodule circumference was the highest,which was 0.909,and the sensitivity and specificity were 90.47%and 80.95%,respectively.Conclusion Ultrasound examination has certain diagnostic value for the diagnosis of LNM in PTMC patients,among them,lesion unclear boundary,microcalcification,nodule invasion and length/nodule circumference≥1/4 are independent risk factors for LNM in PTMC patients,relevant risk factors should be effectively controlled to reduce the risk of LNM in PTMC patients.