Objective To investigate the diagnostic and predictive value of enhanced CT Hounsfield unit value for central lymph node metastasis(CLNM)in patients with Hashimoto’s thyroiditis(HT)complicated with papillary thyroid ...Objective To investigate the diagnostic and predictive value of enhanced CT Hounsfield unit value for central lymph node metastasis(CLNM)in patients with Hashimoto’s thyroiditis(HT)complicated with papillary thyroid carcinoma(PTC).Methods The CT images of HTs with PTC confirmed by operation and pathology from 88 patients were analyzed retrospectively.Among them,50 cases of CLNM were all negative and 38 cases of CLNM were all positive.One lymph node was selected as the study subject in each case.The average HU values(AHUVs)and maximum HU values(MHUVs)were measured on the enhanced CT.The diagnostic efficacy of the two parameters for diagnosing CLNM was analyzed by the receiver operating specificity curve(ROC),and the best cut-off values were obtained,which were used to predict 103 HT with PTC CLNM in the validation group.Results The AHUVs of negative group and positive group were(63.79±15.34)HU and(90.92±18.04)HU(t=8.828,P<0.001).The MHUVs of negative group and positive group were(77.08±15.30)HU and(108.79±18.37)HU,respectively(t=7.615,P<0.001).The AUCs for AHUVs and MHUVs for the diagnosis of CLNM-positive was 0.870 and 0.906,and the cut-off values were 84.0 HU and 96.5 HU,respectively.The sensitivity,specificity,and accuracy of predicting CLNM positivity in the validation group using AHUVs≥84.0 HU were 35.7%,95.1%,and 70.9%,respectively,and MHUVs≥96.5 HU were 38.1%,93.4%,and 70.9%,respectively.Conclusion AHUVs≥84.0 HU and MHUVs≥96.5 HU have high specificity for the diagnosis of HT with PTC CLNM,which can provide an important basis for clinical treatment decision.展开更多
目的探讨CT检查中淋巴结大小和分布状态对单发PTC同侧中央组淋巴结转移(ipsilateral central lymph node metastasis,ICLNM)的诊断价值。方法回顾分析经手术及病理证实的278例直径>1.0cm单发PTC的CT资料,依据同侧中央组淋巴结直径将...目的探讨CT检查中淋巴结大小和分布状态对单发PTC同侧中央组淋巴结转移(ipsilateral central lymph node metastasis,ICLNM)的诊断价值。方法回顾分析经手术及病理证实的278例直径>1.0cm单发PTC的CT资料,依据同侧中央组淋巴结直径将其分为<0.2cm组、0.2~0.4cm组和≥0.4cm组,统计ICLNM阳性和阴性在3组间和组内的分布差异,再依据淋巴结分布状态将0.2~0.4cm组分为浑浊组(≥3枚)和非浑浊组(1~2枚),将≥0.4cm组分为簇状组(≥3枚)和非簇状组(1~2枚),统计浑浊组和非浑浊组、簇状组和非簇状组间的差异。结果278例PTC中,病理证实ICLNM阳性和阴性比例分别为65.8%(183/278)和34.2%(95/278),<0.2cm组、0.2~0.4cm组和≥0.4cm组ICLNM阳性分别占37.3%(31/83)、68.0%(66/97)和87.8%(86/98),组间和组内χ^2和P值分别为51.082和0、16.956和0、49.955和0、11.022和0.001;浑浊组和非浑浊组ICLNM阳性分别占74.0%(57/77)和45%(9/20),χ^2和P值分别为6.151和0.013;簇状淋巴结组和非簇状淋巴结组ICLNM阳性分别占92.6%(50/54)和82%(36/44),χ^2和P分别为2.619和0.106。结论PTC患者的CT检查中,随着中央组淋巴结增多、直径增大,ICLNM阳性比例增加,对于0.2~0.4cm组病例,浑浊征象提示转移可能性更大,对这些征象的准确识别,有助于外科医生采取更彻底的手术治疗方案,对降低术后复发具有重要意义。展开更多
文摘目的构建并验证多灶性甲状腺乳头状癌(multifocal papillary thyroid carcinoma,MPTC)高容量淋巴结转移(high-volume lymph node metastasis,HVM)的列线图预测模型。方法选取2010年1月至2024年1月于杭州市第一人民医院(A中心)及杭州市肿瘤医院(B中心)分别确诊的1146例和234例MPTC患者作为研究对象。A中心患者以7:3的比例采用随机数字表法分成训练集(n=803)和测试集(n=343),B中心34例患者作为外部验证集。通过单因素和多因素Logistic回归分析在训练集中筛选HVM的独立风险因素,并构建列线图预测模型,测试集和外部验证集用以评价模型的泛化能力,通过受试者操作特征曲线下面积(area under the curve,AUC)、敏感度、特异性评价模型的区分能力。结果A中心和B中心发生HVM的概率分别为13.3%和12.8%。单因素及多因素Logistic回归显示,男性(OR=2.91,95%CI:1.835~4.599)、病灶最大径(OR=1.05,95%CI:1.021~1.070)和年龄(OR=0.95,95%CI:0.936~0.972)均为发生HVM的独立风险因素。基于独立风险因素构建列线图预测模型,AUC、敏感度和特异性在训练集中分别为0.767、72.6%和70.2%,在测试集中分别为0.838、94.9%和68.4%,在外部验证集中分别为0.769、63.3%和84.3%。校准曲线显示与理想曲线具有良好的一致性。结论基于临床风险因素构建的预测模型可有效预测MPTC患者发生HVM的概率。
基金Zhejiang Provincial Medical and Health Technology Project(2020RC091,2021RC024)。
文摘Objective To investigate the diagnostic and predictive value of enhanced CT Hounsfield unit value for central lymph node metastasis(CLNM)in patients with Hashimoto’s thyroiditis(HT)complicated with papillary thyroid carcinoma(PTC).Methods The CT images of HTs with PTC confirmed by operation and pathology from 88 patients were analyzed retrospectively.Among them,50 cases of CLNM were all negative and 38 cases of CLNM were all positive.One lymph node was selected as the study subject in each case.The average HU values(AHUVs)and maximum HU values(MHUVs)were measured on the enhanced CT.The diagnostic efficacy of the two parameters for diagnosing CLNM was analyzed by the receiver operating specificity curve(ROC),and the best cut-off values were obtained,which were used to predict 103 HT with PTC CLNM in the validation group.Results The AHUVs of negative group and positive group were(63.79±15.34)HU and(90.92±18.04)HU(t=8.828,P<0.001).The MHUVs of negative group and positive group were(77.08±15.30)HU and(108.79±18.37)HU,respectively(t=7.615,P<0.001).The AUCs for AHUVs and MHUVs for the diagnosis of CLNM-positive was 0.870 and 0.906,and the cut-off values were 84.0 HU and 96.5 HU,respectively.The sensitivity,specificity,and accuracy of predicting CLNM positivity in the validation group using AHUVs≥84.0 HU were 35.7%,95.1%,and 70.9%,respectively,and MHUVs≥96.5 HU were 38.1%,93.4%,and 70.9%,respectively.Conclusion AHUVs≥84.0 HU and MHUVs≥96.5 HU have high specificity for the diagnosis of HT with PTC CLNM,which can provide an important basis for clinical treatment decision.
文摘目的探讨CT检查中淋巴结大小和分布状态对单发PTC同侧中央组淋巴结转移(ipsilateral central lymph node metastasis,ICLNM)的诊断价值。方法回顾分析经手术及病理证实的278例直径>1.0cm单发PTC的CT资料,依据同侧中央组淋巴结直径将其分为<0.2cm组、0.2~0.4cm组和≥0.4cm组,统计ICLNM阳性和阴性在3组间和组内的分布差异,再依据淋巴结分布状态将0.2~0.4cm组分为浑浊组(≥3枚)和非浑浊组(1~2枚),将≥0.4cm组分为簇状组(≥3枚)和非簇状组(1~2枚),统计浑浊组和非浑浊组、簇状组和非簇状组间的差异。结果278例PTC中,病理证实ICLNM阳性和阴性比例分别为65.8%(183/278)和34.2%(95/278),<0.2cm组、0.2~0.4cm组和≥0.4cm组ICLNM阳性分别占37.3%(31/83)、68.0%(66/97)和87.8%(86/98),组间和组内χ^2和P值分别为51.082和0、16.956和0、49.955和0、11.022和0.001;浑浊组和非浑浊组ICLNM阳性分别占74.0%(57/77)和45%(9/20),χ^2和P值分别为6.151和0.013;簇状淋巴结组和非簇状淋巴结组ICLNM阳性分别占92.6%(50/54)和82%(36/44),χ^2和P分别为2.619和0.106。结论PTC患者的CT检查中,随着中央组淋巴结增多、直径增大,ICLNM阳性比例增加,对于0.2~0.4cm组病例,浑浊征象提示转移可能性更大,对这些征象的准确识别,有助于外科医生采取更彻底的手术治疗方案,对降低术后复发具有重要意义。
