超声评分法对甲状腺微小乳头状癌中央区淋巴结转移风险的预测价值

Value of ultrasonographic score in predicting central lymph node metastasis in patients with papillary thyroid microcarcinoma

目的探讨超声评分法对甲状腺微小乳头状癌中央区淋巴结转移风险的术前预测价值。方法回顾278例经手术病理证实甲状腺微小乳头状癌患者的超声图像,根据手术病理分为中央区淋巴结转移组和阴性组。采用多因素回归对两组患者癌灶的各项超声特征进行分析,在其中筛选出中央区淋巴结转移的独立预测因子后进行评分赋值。应用该评分标准对158例验证组甲状腺微小乳头状癌患者进行超声评分,并与手术病理比较,计算超声评分法预测中央区淋巴结转移的ROC曲线AUC,并确定最佳诊断评分值。结果筛选出的独立预测因子为癌灶最大径≥5mm、癌灶多发、癌灶边界不清以及侵犯甲状腺包膜,超声评分法的ROC曲线AUC为0.89,最佳诊断评分值为3分,灵敏度0.788,特异度0.902。结论超声评分法对甲状腺微小乳头状癌中央区淋巴结转移风险具有较高的预测价值。

Objective To evaluate the application of ultrasound(US) scores in predicting central lymph node metastasis in patients with papillary thyroid microcarcinoma(PTMC). Methods Two hundred and seventy eight PTMC patients confirmed by surgical pathology were divided into positive and negative groups according to the status of central lymph node metastasis. The US parameters were analyzed and the predicting factors were screened with multivariate regression analysis. The diagnostic efficiency of US scores was assessed in the verification group(158 PTMC patients). Results The multivariate regression showed that multiple lesions, lesion >5 mm,indistinct border and extra-thyroid invasion were independent predictors for central lymph node metastasis. The area under the receiver-operating characteristics curve(AUC) of US score was 0.89. When use US scores≥3 as a cut-off point, the sensitivity and specificity were 78.8% and 90.2% for predicting central lymph node metastasis. Conclusion US scores can increase the diagnostic accuracy of central lymph node metastasis in patients with PTMC.