Establishment of Risk Prediction Model and Nomogram for Lymph Node Metastasis of Cervical Cancer: Based on SEER Database

Objective: To predict the risk factors of lymph node metastasis in cervical cancer by using large sample clinical data, and to construct and verify the nomogram for predicting lymph node metastasis. Methods: A total of 5940 patients with cervical cancer from 2004 to 2015 in the National Cancer Institute Surveillance Epidemiology and End Results database were retrospectively screened and randomly assigned to training group (n = 4172) and validation group (n = 1768). Multivariate Logistic regression analysis was used, and the optimal model was selected according to AIC or BIC and likelihood ratio test, and a nomogram was drawn. The accuracy and robustness of the prediction model were evaluated in three aspects: discrimination, calibration and clinical net benefit. Results: The prediction model based on race, tumor tissue differentiation degree, tumor histopathological type, distant metastasis of tumor, tumor diameter and other risk factors was successfully established and a nomogram was constructed. The AUCs of training group and validation group were: 0.736 and 0.714, respectively. And the p-values of the Hosmer-Lemeshow test were 0.28 and 0.11, respectively. The calibration curve was in good agreement with the ideal curve. It had high accuracy and applicability after internal verification. Conclusion: A prediction model is constructed based on the risk factors of lymph node metastasis of cervical cancer. The nomogram has a good effective prediction and can provide a theoretical basis for clinicians to assess the disease quickly before surgery.

Progress in the Study of Lymph Node Metastasis in Early-stage Cervical Cancer

Spread into regional lymph node is the major route of metastasis in cervical cancer. Although lymph node status is not involved in the International Federation of Gynecology and Obstetrics staging system of uterine cervical cancer, the presence or absence of lymph node metastasis provides important information for prognosis and treatment. In this review, we have attempted to focus on the incidence and patterns of lymph node metastasis, and the issues surrounding surgical assessment of lymph nodes. In addition, the preoperative prediction of lymph node status, as well as the intraoperative assessment by sentinel nodes will be reviewed. Finally, lymph node micrometastasis also will be discussed.

Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma

BACKGROUND Cervical lymph node metastasis in papillary thyroid carcinoma(PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients; however, it is not accurate in determining lymph node metastasis.AIM To evaluate the value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in PTC.METHODS A total of 94 patients with PTC were recruited. According to pathological results,lymph nodes were divided into two groups: metastatic group(n = 50) and reactive group(n = 63). The routine ultrasound findings, contrast-enhanced ultrasound and elastography data were recorded and compared. Logistic regression was used to generate predictive probability distributions for the diagnosis of lymph node metastasis with different indicators. Receiver operating characteristic curve analysis was used to test the efficacy of contrast-enhanced ultrasound combined with elastography based on routine ultrasound in evaluating PTC cervical lymph node metastasis.RESULTS The ratio of long diameter/short diameter(L/S) ≤ 2, irregular marginal morphology, missing lymphatic portal, peripheral or mixed blood flow distribution, peak intensity(PI), non-uniform contrast distribution and elasticity score in the metastatic group were significantly higher than those in the reactive group(P < 0.05). L/S ratio, missing lymphatic portal, PI and elasticity score had a significant influence on the occurrence of PTC cervical lymph node metastasis(P< 0.05). Furthermore, the area under the curve(AUC) for lymph node metastasis diagnosed using the combination of PI ratio, elasticity score, missing lymphatic portal and LS was 0.936, which was significantly higher than the AUC for PI ratio alone. The difference was statistically significant(P < 0.05). The fitting equation for the combined diagnosis was logit(P) =-12.341 + 1.482 × L/S ratio + 3.529 ×missing lymphatic portal + 0.392 × PI + 3.288 × elasticity score.CONCLUSION Based on the gray-scale ultrasound, the combination of contrast-enhanced ultrasound and elastography can accurately assess PTC cervical lymph node metastasis.

Relationship between Expression of Vascular Endothelial Growth Factor and Cervical Lymph Node Metastasis in Papillary Thyroid Cancer: A Meta-analysis

The aim of the present study was to examine the relationship between the protein expression of vascular endothelial growth factor（VEGF） and lymph node metastasis（LNM） in papillary thyroid cancer（PTC）. VEGF-related articles that had been published until August 2016 were searched from the Pub Med, EMBASE, and MEDLINE to identify the risk factors of LNM in PTC. Rev Man 5.3 software was used for the meta-analysis. Finally, 9 articles met the inclusion criteria and were included in our meta-analysis. LNM was found to be present in 176 of 318 patients（57.8%） with high VEGF expression and in 71 of 159 patients（47.0%） with low VEGF expression. The overall OR was 2.81（95% confidence interval, 1.49–5.29）. LNM occurred more frequently in patients with high VEGF expression than in those with low VEGF expression（P=0.001）. Heterogeneity was markedly decreased in the subgroup analyses of LNM in terms of the patients＇ country of origin and the detection methods. Our meta-analysis concluded that the VEGF protein expression is associated with LNM in PTC.

Clinical and Sonographic Assessment of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma

The purpose of this study was to assess the differences in clinical and sonographic features of papillary thyroid carcinoma（PTC） between cervical lymph node metastatic（CLNM） and nonmetastatic groups.Clinical data of PTC patients（414 patients with 624 malignant nodules） who underwent a preoperative ultrasonography and surgery between June 2010 and March 2015 at Renmin Hospital of Wuhan University were retrospectively analyzed.Clinical factors,preoperative ultrasound features and the final pathological findings were obtained.The differences in the sonographic features of PTC between the CLNM group and the non-CLNM group were analyzed.There were 187 CLNM and 227 non-CLNM patients.The median age at the diagnosis of this cohort was 45.4 years old（ranging from 18 to 77 years）.Ultrasonographic parameters that were significantly associated with CLNM [OR=2.569（1.502,4.393）,P〈0.001）] were as follows：the mulifocality of the nodules,size over 2 cm,the presence of microcalcifications,the distance ratio（DR） pattern showing the contact of the nodules with the thyroid capsule,and the extracapsular spread of the nodules.No significant differences in age,gender,thyroid stimulating hormone（TSH） levels and other ultrasonography parameters were found between the CLNM and the non-CLNM groups.Therefore,our results suggest that a larger size,microcalcifications,mulifocality,and the DR pattern showing the contact of the nodules with the thyroid capsule and extracapsular spread are significantly more indicative of CLNM in PTC.

Separate lateral parametrial lymph node dissection improves detection rate of parametrial lymph node metastasis in early-stage cervical cancer: 10-year clinical evaluation in a single center in China

Objective: To investigate the clinical significance of separate lateral parametrial lymph node dissection(LPLND) in improving parametrial lymph node(PLN) and its metastasis detection rate during radical hysterectomy for early-stage cervical cancer.Methods: From July 2007 to August 2017, 2,695 patients with cervical cancer in stage IB1-IIA2 underwent radical hysterectomy were included. Of these patients, 368 underwent separate dissection of PLNs using the LPLND method, and 2,327 patients underwent conventional radical hysterectomy(CRH). We compared the surgical parameters, PLN detection rate and PLN metastasis rate between the two groups.Results: Compared with CRH group, the rate of laparoscopic surgery was higher(60.3% vs. 15.9%, P<0.001),and the blood transfusion rate was lower(19.0% vs. 29.0%, P<0.001) in the LPLND group. PLNs were detected in 356 cases(96.7%) in the LPLND group, and 270 cases(11.6%) in the CRH group(P<0.001), respectively. The number of PLNs detected in the LPLND group was higher than that in the CRH group(median 3 vs. 1, P<0.001).The PLN metastases were detected in 25 cases(6.8%) in the LPLND group, and 18 cases(0.8%) in the CRH group(P<0.001), respectively. In multivariable analysis, LPLND is an independent factor not only for PLN detection [odds ratio(OR)=228.999, 95% confidence interval(95% CI): 124.661-420.664;P<0.001], but also for PLN metastasis identification(OR=10.867, 95% CI: 5.381-21.946;P<0.001).Conclusions: LPLND is feasible and safe. The surgical method significantly improves the detection rate of PLN and avoids omission of PLN metastasis during radical hysterectomy for early-stage cervical cancer.

Comparison of efficacy and safety between late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy for cervical cancer complicated with pelvic lymph node metastasis

Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated with pelvic lymph node metastasis. Methods Sixty patients with cervical cancer complicated with pelvic lymph node metastasis who were admitted to our hospital from January 2013 to January 2015 were enrolled. The patients were randomly divided into the late-course dose-increasing IMRT group and the simultaneous integrated dose-increasing IMRT group, with 30 cases included in each group, respectively. All patients were concurrently treated with cisplatin. After treatment, the clinical outcomes of the two groups were compared. Results The remission rate of symptoms in the simultaneous integrated dose-increasing IMRT group was significantly higher than that in the late-course dose-increasing IMRT group(P < 0.05). The follow-up results showed that the overall survival time, progression-free survival time, and distant metastasis time of patients in the simultaneous integrated dose-increasing IMRT group were significantly longer than those in the late-course dose-increasing IMRT group(P < 0.05). The recurrent rate of lymph nodes in the radiation field in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in the incidence of cervical and vaginal recurrence and distant metastasis between the two groups(P > 0.05). The radiation doses of Dmax in the small intestine, D1 cc(the minimum dose to the 1 cc receiving the highest dose) in the bladder, and Dmax in the rectum in the simultaneous integrated dose-increasing IMRT group were significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in intestinal D2 cc(the minimum dose to the 2 cc receiving the highest dose) between the two groups(P > 0.05). The incidence of bone marrow suppression in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group.Conclusion The application of simultaneous integrated dose-increasing IMRT in the treatment of cervical cancer patients complicated with pelvic lymph node metastasis can significantly control tumor progression, improve the long-term survival time, and postpone distant metastasis time with high safety.

Residual tumor and central lymph node metastasis after thermal ablation of papillary thyroid carcinoma: A case report and review of literature

BACKGROUND Debate exists regarding the use of thermal ablation(TA)to treat papillary thyroid carcinoma(PTC).Some studies have recommended TA as a new,ef
cient and safe technology for PTC.In this article,we report one case of a residual tumor and central lymph node metastasis(CLNM)after TA for PTC.CASE SUMMARY A 63-year-old female underwent bilateral ultrasound(US)-guided radiofrequency ablation for PTC.Three months later,she was diagnosed as thyroid cancer with suspected CLNM by US and contrast-enhanced computed tomography.The subsequent fine-needle aspiration(FNA)biopsies were negative.Due to her strong personal preference,she underwent total thyroidectomy and central lymph node dissection.Local tissue adhesion and a difficult dissection were noted during the operation.The pathology of the frozen sections during the operation was still negative.The final pathology results of paraffin-embedded sections revealed residual tumor cells at the edge of the PTC and CLNM.CONCLUSION TA may lead to a residual tumor in patients with PTC.Follow-up using US and FNA biopsy may not be adequate to evaluate the residual tumor.TA should be carefully considered in PTC treatment.

临床淋巴结阴性甲状腺微小乳头状癌患者中央区淋巴结转移危险因素分析

目的 探讨临床淋巴结阴性(cN0)甲状腺微小乳头状癌(PTMC)患者颈中央区淋巴结转移(CLNM)预测模型。方法 本研究纳入2015—2020年在西安交通大学第一附属医院耳鼻咽喉头颈外科手术确诊的cN0-PTMC患者共1271例,根据手术记录和术后病理结果统计年龄、性别、肿瘤最大径、肿瘤位置、侧别、BRAFV600E基因突变、伴结节性甲状腺肿(NG)和桥本氏甲状腺炎(HT)情况、腺外侵犯、被膜侵犯、颈淋巴结转移等临床病理资料,分析CLNM与各临床病理参数的相关性。结果 采用年龄45岁作为分类标准进行单因素分析。结果显示男性患者、年龄、肿瘤直径、是否伴HT、是否多灶性均与cN0-PTMC发生CLNM相关(P<0.05)。伴NG、BRAFV600E基因突变、肿瘤位置、腺外侵犯、肿瘤侧、被膜侵犯均与cN0-PTMC发生CLNM无相关性(P>0.05)。继续进行非条件Logistic回归分析,结果显示男性患者(OR=1.929,95%CI:1.465~2.541),年龄≤45岁(OR=2.581,95%CI:2.004~3.324),多灶性(OR=1.675,95%CI:1.276~2.197)是cN0-PTMC患者发生CLNM的独立危险因素;直径≤5 mm(OR=0.603,95%CI:0.463~0.785)和伴HT(OR=0.642,95%CI:0.452~0.913)是cN0-PTMC患者发生CLNM的保护因素。伴HT是cN0-PTMC患者BRAFV600E基因野生型的危险因素(OR=3.454,95%CI:1.865~6.397)。结论 男性患者、年龄≤45岁、肿瘤直径>5 mm、不伴HT、多灶性是cN0-PTMC患者发生CLNM的独立危险因素。伴HT是此类患者发生BRAFV600E基因突变的保护因素,与其他临床病理特征无相关性。

基于超声造影特征构建列线图预测甲状腺微小乳头状癌颈淋巴结转移风险

目的通过分析甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)患者临床资料、结节超声和超声造影(contrast-enhanced ultrasound,CEUS)特征建立预测颈淋巴结转移(lymph node metastasis,LNM)风险的列线图模型,为合理规范的临床决策提供依据。方法回顾性分析2020年12月1日至2021年12月31日在新疆医科大学第一附属医院行甲状腺手术治疗的PTMC患者404个结节临床资料,应用随机函数按照7∶3分为建模组(n=282)与验证组(n=122)。应用Logistic回归分析筛选PTMC颈淋巴结转移的独立相关因素,构建列线图,以曲线下面积(area under curve,AUC)评估模型诊断效能,应用验证组数据进行外部验证。结果构建模型显示结节边缘、声晕、多灶性、包膜下生长或侵犯包膜、消退模式是颈淋巴结转移的危险因素(P<0.05);建模组AUC为0.747(0.690~0.804),最佳cut-off值为0.430,灵敏度0.65,特异度0.73;验证组AUC为0.778(0.697~0.860),最佳cut-off值为0.419,灵敏度0.64,特异度0.81。结论本研究构建的列线图可个体化预测PTMC颈淋巴结转移的风险,超声和超声造影特征有助于指导高风险人群的临床决策。

多模态超声在评估甲状腺微小乳头状癌颈部中央区淋巴结转移中的价值

目的:评估多模态超声预测甲状腺微小乳头状癌(PTMC)颈部中央区淋巴结转移的有效性。方法:收集110例PTMC患者的临床指标和多模态超声特征,并与颈部中央区淋巴结转移行单因素及多因素分析。结果:<42岁、男性PTMC患者更易发生颈部中央区淋巴结转移(均P<0.05);结节最大截面横径≥0.52 cm或纵径≥0.66 cm是PTMC发生颈部中央区淋巴结转移的高危因素(均P<0.01);微钙化和弹性评分≥4分的PTMC患者更易发生颈部中央区淋巴结转移(均P<0.01)。多因素分析显示,仅微钙化是PTMC颈部中央区淋巴结转移的独立危险因素。结论:对结节内伴微钙化的PTMC患者,应加强颈部中央区淋巴结的术前评估和术中治疗。

男性甲状腺微小乳头状癌临床特点及中央区淋巴结转移危险因素分析

目的分析男性甲状腺微小乳头状癌的临床特点,并探讨其发生中央区淋巴结转移的危险因素。方法回顾分析2018年1月—2022年12月我科收治的首次手术治疗的甲状腺微小乳头状癌患者共743例,男性152例作为研究组,女性591例作为对照组,比较2组患者的临床病理资料,并使用单因素和多因素统计学方法分析男性甲状腺微小乳头状癌患者中央区淋巴结转移的危险因素。结果2组患者年龄、肿瘤最大径、肿瘤多灶性、肿瘤分布及颈侧区淋巴结转移差异均无统计学意义(P值均>0.05),2组患者肿瘤包膜侵犯、合并桥本甲状腺炎及中央区淋巴结转移情况差异均具有统计学意义(P值均<0.01)。单因素分析显示肿瘤最大径>5 mm、多灶、双侧分布、有包膜侵犯为男性甲状腺微小乳头状癌患者中央区淋巴结转移的危险因素,二元logistic多因素回归分析显示肿瘤最大径>5 mm、包膜侵犯为男性甲状腺微小乳头状癌患者发生中央区淋巴结转移的独立危险因素。结论相对于女性甲状腺微小乳头状癌患者,男性甲状腺微小乳头状癌患者更易出现包膜侵犯,中央区淋巴结转移率更高。临床对于肿瘤最大径>5 mm、有包膜侵犯的男性甲状腺微小乳头状癌患者要尤为重视中央区淋巴结的清扫。

单侧甲状腺乳头状癌伴同侧颈侧区淋巴结转移患者发生对侧中央区淋巴结转移的影响因素

目的探讨伴同侧颈侧区淋巴结转移(LLNM)的单侧甲状腺乳头状癌(PTC)患者对侧中央区淋巴结(Cont-CLNs)转移的影响因素。方法选取2018年7月至2022年7月江苏省原子医学研究所附属江原医院收治的LLNM-PTC患者127例,根据其是否发生Cont-CLNs转移,分成转移组(n=68)和非转移组(n=59)。收集患者的资料,包括性别、年龄、肿瘤大小、肿瘤回声、血流信号、有无微钙化、肿瘤数量、病变腺叶、结节性甲状腺囊肿、被膜侵犯、有无桥本甲状腺炎以及患侧中央区淋巴结、气管前淋巴结与喉前淋巴结转移发生率与术后并发症情况。采用二元logistic回归模型分析LLNM-PTC患者发生Cont-CLNs转移的影响因素。采用SPSS 20.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ^(2)检验。结果转移组男性、微钙化、多发性肿瘤、被膜侵犯占比分别为75.00%(51/68)、47.06%(32/68)、55.88%(38/68)、47.06%(32/68),高于非转移组的37.29%(22/59)、16.95%(10/59)、18.64%(11/59)、15.25%(9/59),且转移组肿瘤最大径大于非转移组(P<0.05)。转移组患侧中央区淋巴结、气管前淋巴结、喉前淋巴结转移率分别为51.47%(35/68)、44.12%(30/68)、50.00%(34/68),高于非转移组的20.34%(12/59)、15.25%(9/59)、16.95%(10/59),差异有统计学意义(P<0.05)。二元logistic回归分析显示,男性、肿瘤太大、微钙化、多发性肿瘤、被膜侵犯、患侧中央区淋巴结转移、气管前淋巴结转移、喉前淋巴结转移是患者发生Cont-CLNs转移的独立危险因素,差异有统计学意义(P<0.05)。结论LLNM-PTC患者发生Cont-CLNs转移受多种因素影响,包括性别、肿瘤大小、微钙化、肿瘤数量、被膜侵犯以及患侧中央区、气管前、喉前的淋巴结转移,日后诊疗中需引起重视。

运用倾向匹配评分分析盆腔淋巴结转移对早期宫颈癌患者生存的影响

目的:通过使用倾向匹配评分(propensity score matching analysis, PSM)进一步验证和评估盆腔淋巴结转移(pelvic lymph node metastasis, PLNM)对早期宫颈癌患者的生存影响。方法:共纳入2009年01月01日至2016年12月31日间陕西省人民医院宫颈癌根治术后患者533例,其中429例盆腔淋巴结阴性(N0组)、104例盆腔淋巴结阳性(N1组患者)。采用1∶1进行PSM,共104对进入匹配后分析。结果:在PSM前,N0组及N1组在宫颈间质浸润深度(cervical stromal invasion, DSI)、淋巴血管间隙侵犯(lymphovascular space invasion, LVSI)、肿瘤大小及2009 FIGO分期上存在明显差异(P<0.05),经PSM后,匹配后两组在各临床病理特征间均无明显差异(P>0.05)。在PSM前,N0组5年总生存期(overall survival, OS)(85.8%)明显优于N1组(72.1%),经PSM后,匹配后N0组5年OS (83.7%)仍明显优于N1组(72.1%),以上差异均具有统计学意义(P<0.05)。PSM前Cox单因素及多因素分析结果显示:DSI、LVSI、盆腔淋巴结状态及肿瘤大小是宫颈癌患者独立预后影响因素。PSM后Cox单因素及多因素分析结果显示:DSI、LVSI、盆腔淋巴结状态仍是宫颈癌患者独立预后影响因素。结论:无论在PSM前还是在PSM后,盆腔淋巴结转移与早期宫颈癌患者较差的5年OS相关。

超声及血清CK-19、Galectin-3、miRNA-363联合诊断PTMC颈部淋巴结转移的临床价值

目的 研究超声及血清细胞角蛋白19(CK-19)、半乳糖凝集素3(Galectin-3)及微小核糖核酸-363(miRNA-363)联合诊断甲状腺微小乳头状癌(PTMC)颈部淋巴结转移(CLNM)的临床价值。方法 回顾性选取2021年7月至2023年6月在天津市环湖医院诊断的PTMC患者92例纳入研究组,选择同期本院收治的结节性微小甲状腺肿患者92例纳入对照组。观察两组病灶情况及超声特点;比较两组血清CK-19、Galectin-3、miRNA-363水平,研究组是否发生CLNM患者病灶超声特点及血清CK-19、Galectin-3、miRNA-363水平。分析PTMC~CLNM超声特点与血清CK-19、Galectin-3、miRNA-363水平的相关性。结果 研究组多枚病灶、病灶>0.5 mm、病灶纵横比≥1、病灶形态不规则、病灶边缘模糊、病灶微钙化、病灶低回声、淋巴结肿大占比分别为70.65%、71.74%、82.61%、61.96%、72.83%、80.43%、84.78%、70.65%,均大于对照组(31.52%、52.17%、27.17%、25.00%、19.57%、15.22%、66.30%、22.83%),差异均有统计学意义(P<0.05)。研究组血清CK-19、Galectin-3水平分别为(30.45±3.31)、(4.68±0.48)μg/L,均高于对照组[(7.05±0.73)、(1.72±0.19)μg/L],血清miRNA-363水平为(2.89±0.30) fmol/L,低于对照组[(4.30±0.46) fmol/L],差异均有统计学意义(P<0.05)。研究组发生CLNM患者多枚病灶、病灶形态不规则、病灶边缘模糊、病灶微钙化、淋巴结肿大占比分别为90.91%、86.36%、95.45%、100.00%、90.91%,均大于未发生CLNM患者(64.29%、54.29%、0、25.00%、64.29%),差异均有统计学意义(P<0.05)。研究组发生CLNM患者血清CK-19、Galectin-3水平(41.20±4.42)、(5.94±0.62)μg/L,均高于未发生CLNM患者[(24.36±2.71)、(3.25±0.34)μg/L],血清miRNA-363水平为(2.14±0.23) fmol/L,低于未发生CLNM患者[(3.46±0.36) fmol/L],差异均有统计学意义(P<0.05)。经Pearson相关分析,CLNM患者多枚病灶、病灶形态不规则、病灶边缘模糊、淋巴结肿大及血清CK-19、Galectin-3、miRNA-363水平均与CLNM呈正相关(P<0.05)。结论 超声及血清CK-19、Galectin-3、miRNA-363联合诊断PTMC~CLNM具有较高的临床价值。

基于超声和临床指标的复合模型预测甲状腺乳头状癌术后颈部淋巴结转移风险

目的:探索术前超声图像特征结合临床指标对甲状腺乳头状癌(PTC)术后颈部淋巴结转移风险的预测价值。方法:回顾性收集2019年1月至2020年12月在温州医科大学附属第一医院接受二次手术并经病理证实的PTC颈部淋巴结转移患者43例,作为转移组。同时,收集我院2013年1月至2014年12月收治的89例自首次PTC手术起随访至少8年,未出现颈部淋巴结复发的患者作为未转移组。按照7:3的比例随机抽样将患者分为训练集(n=92)和验证集(n=40),在训练集中通过单因素和多因素Logistic回归分析,构建预测模型并绘制列线图使模型可视化,使用验证集对模型进行验证,通过ROC曲线和决策曲线分析(DCA)对模型效能和临床价值进行评估。结果:转移组与未转移组患者间手术方法、术中淋巴结转移、甲状腺结节部位、回声特性、甲状腺结节最大径线、超声提示淋巴结肿大、淋巴结长径/短径比值以及淋巴结血流特征差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示手术方式(全切vs.部分切除,OR=0.332,95%CI=0.134~0.828,P=0.018)、术中淋巴结转移(转移vs.未转移,OR=2.978,95%CI=1.112~7.953,P=0.030)、甲状腺结节部位(中部vs.下极,OR=6.624,95%CI=1.986~22.095,P=0.002)及甲状腺结节最大径线(OR=1.064,95%CI=1.002~1.130,P=0.042)为术后颈部淋巴结转移的独立影响因素。该模型在训练集中的AUC为0.872(95%CI=0.795~0.949),在验证集中的AUC为0.863(95%CI=0.749~0.976),DCA显示阈值概率在0.1~0.7时该模型预测术后PTC颈部淋巴结转移发生的风险净收益高。结论:本研究基于术前超声图像特征及临床病理指标构建的预测模型可有效预测PTC术后颈部淋巴结转移的风险,对于临床决策有一定的参考价值。

基于深度学习的宫颈癌淋巴结转移预测

目的:基于深度学习,利用T_(2)加权成像(T_(2)WI)序列的高分辨特性获得宫颈癌淋巴结的结构信息,并预测淋巴结是否转移;利用弥散加权成像(DWI)序列的功能特性,获取淋巴结区域,并预测淋巴结是否转移;综合多模态MRI数据,预测淋巴结是否转移。方法:收集2021年6月至2022年5月年新疆维吾尔自治区人民医院收治的52例宫颈癌患者的多参数MRI影像数据以及病理检查数据作为训练集,另收集2022年6月至2023年5月新疆维吾尔自治区人民医院收治的150例宫颈癌患者多参数MRI影像数据以及病理检查数据作为验证集。训练集52例宫颈癌患者均接受MRI扫描,扫描序列包括T_(2)WI和DWI序列。对训练集52例宫颈癌患者的多参数MRI影像学图像进行非均匀性校正和标准化的预处理后,通过渐进演化空洞卷积对T_(2)WI图像进行分割,在扩大感受野的同时,有效降低空洞对图像丢失的影响;通过基于注意力网络机制的深度学习模型引导网络在预测时更关注淋巴结区域,并为预测结果提供一定程度的解释性;通过多模态协同学习模型实现T_(2)WI和DWI序列在淋巴结性质预测任务之间的经验共享。采用验证集患者的图像资料对基于多模态协同学习模型的淋巴结转移预测模型进行验证。结果:验证集150例患者中良性淋巴结585枚,恶性淋巴结65枚,其良恶性淋巴结在大小(长径、短径)和边界上存在差异,差异有统计学意义(x^(2)=8.437、143.100、104.608,P<0.05)。验证集150例患者中48例患者出现淋巴结转移,基于多模态协同学习模型的淋巴结性质预测模型准确预测出46例患者出现淋巴结转移,准确预测出99例患者未发生淋巴结转移,预测准确率为96.67%。结论:渐进演化空洞卷积结合U-Net框架完成了对T_(2)WI宫颈癌影像的多目标自动分割任务,基于注意力网络机制的深度学习模型完成了动态关注淋巴结区域的任务,多模态协同学习模型有效地避免了特征层融合之后特征空间分布的改变。

FNAC联合FNA-Tg检测在甲状腺乳头状癌颈侧区淋巴结转移中的诊断价值

目的探讨超声引导下细针穿刺细胞学检查(FNAC)联合细针穿刺洗脱液甲状腺球蛋白(FNA-Tg)在甲状腺乳头状癌(PTC)颈侧区淋巴结转移中的诊断价值。方法回顾性分析行颈侧区淋巴结清扫术的200例PTC患者的临床资料,术前超声评估颈侧区有可疑转移淋巴结236枚,术后病理证实转移性淋巴结178枚,非转移性淋巴结58枚,所有患者均行FNAC、FNA-Tg检查。以术后病理结果为金标准,比较FNAC、FNA-Tg、FNAC联合FNA-Tg的诊断结果及诊断效能。结果FNAC联合FNA-Tg诊断PTC颈侧区淋巴结转移的灵敏度、准确度、阴性预测值高于单一诊断方法,差异具有统计学意义(P<0.05)。结论FNAC与FNA-Tg检测方法在临床中能够用于诊断PTC颈侧区淋巴结转移,两者联合检测可以进一步提高诊断效能,值得推广及应用。