甲状腺乳头状癌超声征象与颈部淋巴结转移的相关性分析

Correlation between Ultrasonographic Features and Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma

[目的]分析甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者颈部淋巴结转移与超声征象间的关系。[方法]收集行手术治疗的968例PTC患者的超声及临床资料,单因素及多因素分析超声征象与淋巴结转移的关系。综合多个超声征象评估PTC患者发生颈部淋巴结转移的可能性,受试者工作特征曲线(ROC曲线)评价其应用价值。[结果]超声术前诊断中央区淋巴结转移(central lymph node metastasis,CLNM)的灵敏性、特异性分别为20.2%、83.2%,侧颈区淋巴结转移(lateral lymph node metastasis,LLNM)的灵敏性、特异性分别为84.1%、88.7%。男性、<45岁、直径>1.0cm和伴钙化是CLNM的独立危险因素(P均<0.01);男性、<45岁、结节直径>1.0cm、上极结节、钙化及A/T≥1是LLNM的独立危险因素(P均<0.01);男性、直径>1.0cm、上极结节、钙化和A/T≥1是跳跃性淋巴结转移的独立危险因素(P均<0.01)。ROC曲线评价预测PTC发生颈部淋巴结转移的曲线下面积(AUC)是0.812(P<0.01)。[结论 ] PTC患者颈部淋巴结转移具有一定的超声特点,多参数预测转移性淋巴结具有一定临床意义,为术前评估淋巴结情况及临床诊治提供更多参考价值。

[Objective]To investigate the correlation between ultrasonographic features and cervical lymph node metastasis in papillary thyroid cancer(PTC).[Methods]The pre-operative ultrasonographic findings and post-operative pathological results of 968 PTC patients were retrospectively reviewed.Univariate and multivariate analyses were used to evaluate the relationship between ultrasonographic characteristics and lymph node metastasis.The receiver operating characteristic curve(ROC)was used to evaluate the efficacy of ultrasonographic features in diagnosis of lymph node metastasis.[Results]The sensitivity and specificity of pre-operative ultrasound diagnosis of PTC central lymph node metastasis(CLNM)were 20.2%and 83.2%,respectively.The sensitivity and specificity of lateral lymph node metastasis(LLNM)were 84.1%and 88.7%,respectively.Multivariate analysis revealed that male sex,age<45 years,tumor size>1.0 cm,and calcification were risk factors of CLNM(all P<0.01);age<45 years,tumor size>1.0 cm,located in upper pole,calcification and A/T≥1 were risk factors of LLNM(all P<0.01);male sex,tumor size>1.0 cm,located in upper pole,calcification and A/T≥1 were risk factors for skip metastasis of neck lymph node(all P<0.01).AUC of ROC curve was 0.812(all P<0.01).[Conclusion]The ultrasonographic features of lymph node metastasis in PTC patients are characteristic,which are of value in improving diagnosis.