超声预测老年甲状腺乳头状癌患者颈部淋巴结转移的效能及相关超声征象分析

doi:10.16150/j.1671-2870.2022.03.009

摘要/Abstract

摘要：

目的：分析超声预测老年甲状腺乳头状癌（papillary thyroid carcinomas, PTC）的颈部淋巴结转移效能及相关超声影像特征。方法：回顾分析2021年1月至2021年10月上海交通大学医学院附属瑞金医院收治的232例PTC老年患者（≥60岁）术前的超声图像特征,并根据其术后病理提示有无颈部淋巴结转移,分为转移组与非转移组。计算超声诊断PTC颈部淋巴结转移的效能,采用因素分析颈部淋巴结转移的超声征像,采用Logistic回归模型分析提示PTC颈部淋巴结转移的原发灶超声征像,并构建多因素模型,利用受试者操作特征（receiver operator characteristic,ROC）曲线评价危险因素模型预测PTC颈部淋巴结转移的价值。结果：232例PTC老年患者中,30.6%的患者（71例）术后病理示存在颈部淋巴结转移。超声诊断PTC颈部淋巴结转移的灵敏度为40.8%（29/232）,特异度为93.2%（150/232）,阳性预测值为72.5%（29/40）,阴性预测值为78.1%（150/192）。单因素分析示,术前超声征象中,原发灶结节大小≥10 mm、微钙化、紧贴包膜及彩色多普勒血流显像（color Doppler flow imaging,CDFI）示血流丰富的患者颈部淋巴结转移率较高（P<0.05）。多因素分析示,术前超声影像示原发灶结节大小≥10 mm[优势比（odd ratio,OR)=4.093,95%置信区间（confidence interval,CI）为1.933~8.666,P<0.001]及紧贴包膜（OR=2.177,95%CI为1.101~4.302,P=0.025）是颈部淋巴结转移的独立危险因素;二者同时存在诊断PTC颈部淋巴结转移的曲线下面积（area under the value,AUC）为0.709,较单个征象诊断的AUC大（紧贴包膜的AUC为0.602;结节大小≥10 mm的AUC为0.668）。结论：在老年PTC患者中,淋巴结转移者约占30.6%,术前超声征象中的原发灶结节大小≥10 mm、紧贴包膜是肿瘤发生颈部淋巴结转移的独立危险因素。

关键词: 超声检查, 甲状腺乳头状癌, 淋巴结转移, 老年

Abstract:

Objective: To explore the efficacy of ultrasonic examination for diagnosing cervical lymph node metastasis in elderly patients with papillary thyroidc arcinoma(PTC), and to analyze the related ultrasonographic characteristics. Methods: A total of 232 patients ≥60 years with PTC admitted to Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between January 2021 and October 2021, were included in the retrospective analysis. According to postoperative pathology, the efficacy of ultrasound in predicting cervical lymph node metastasis were calculated. Multivariate logistic regression model was used to analyze the risk factor for cervical lymph node metastasis and risk factors were used to construct multi-factor model of risk for predicting cervical lymph node metastasis. Receiver operator characteristic (ROC) curves was used to evaluate the value of the model for predicting lymph node metastasis in elderly participants with PTC. Results: Rate of cervical lymph node metastasis was 30.6% (71 cases). The sensitivity, specificity, positive predictive va-lue and negative predictive value of ultrasound for cervical lymph node metastasis were 40.8%(29/232), 93.2% (150/232), 72.5% (29/40) and 78.1% (150/192). Univariate analysrs showed that the cervical lymph node metastasis rate was higher in patients with nodule size ≥10 mm, microcalcification, abundant color Doppler flow imaging (CDFI) blood flow, or the distance between the nodule and capsule <1 mm by preoperative ultrasound scanning (P<0.05). Multivariate logistic regression analysis demonstrated that preoperative ultrasonographic nodule size ≥10 mm (odds ratio[OR]=4.093, 95%CI: 1.933-8.666, P<0.001) and the distance between the nodule and capsule<1 mm (OR=2.177, 95%CI: 1.101-4.302, P=0.025) were independent risk factors for lymph node metastasis in elderly participants with PTC. The area under the curve(AUC) of combined these two independent risk factors for diagnosing cervical lymph node metastasis was 0.709. The AUC value was larger than either a risk factor. (AUC for the distance between the nodule and capsule<1 mm, was 0.602, and AUC for preoperative ultrasonographic nodule size ≥10 mm was 0.668). Conclusions: Proportion of cervical lymph node metastasis in the elderly patients with PTC. Large nodule size (≥10 mm) and close distance between the nodule and capsule (<1 mm) are independent risk factors for cervical lymph node metastasis for elderly patients with PTC.

Key words: Ultrasonography, Papillary thyroid carcinoma, Lymph node metastasis, Elderly

中图分类号:

R736.1

徐琛莹, 李嫣然, 倪晓枫, 徐上妍, 林青. 超声预测老年甲状腺乳头状癌患者颈部淋巴结转移的效能及相关超声征象分析[J]. 诊断学理论与实践, 2022, 21(03): 343-348.

XU Chenying, LI Yanran, NI Xiaofeng, XU Shangyan, LIN Qing. Efficacy of ultrasonic examination in predicting cervical lymph node metastasis in elderly patients with papillary thyroid carcinoma and analysis of related ultrasound signs[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(03): 343-348.

图/表 4

表1

老年PTC患者颈部淋巴结转移的术前一般临床及超声资料分析[例（%）]

临床特征	总数（n=232）	颈部淋巴结转移[例（%）]		P值
临床特征	总数（n=232）	有（n=71）	无（n=161）	P值
年龄（岁）	65.06±3.94	64.65±3.91	65.24±3.95	0.290
60~69	199（85.9%）	62（87.3%）	137（85.1%）	0.654
≥70	33（14.2%）	9（12.7%）	24（14.9%）
性别				0.980
男	39（16.8%）	12（16.9%）	27（16.8%）
女	193（83.2%）	59（83.1%）	134（83.2%）
BMI（kg/m²）	24.39±3.26	24.56±3.26	24.32±3.27	0.599
恶性肿瘤家族史				0.427
有	18（7.8%）	7（9.9%）	11（6.8%）
无	214（92.2%）	64（90.1%）	150（93.2%）
结节部位				0.052
单侧	173（74.6%）	47（66.2%）	126（78.3%）
多侧	59（25.4%）	24（33.8%）	35（21.7%）
结节个数				0.155
单个	162（70.3%）	45（63.4%）	117（72.7%）
多个	70（29.7%）	26（36.6%）	44（27.3%）
结节大小（mm）	10.01±6.92	13.40±8.74	8.52±5.33	<0.001
<10	152（65.5%）	30（42.3%）	122（75.8%）	<0.001
≥10	80（34.5%）	41（57.7%）	39（24.2%）
结节方位				0.063
垂直	151（65.1%）	40（56.3%）	111（68.9%）
水平	81（34.9%）	31（43.7%）	50（31.1%）
结节内部结构				0.578
实性	223（96.1%）	69（97.2%）	154（95.7%）
非实性	9（3.9%）	2（2.8%）	7（4.3%）
结节内部回声				0.220
极低回声	13（5.6%）	2（2.8%）	11（6.8%）
非极低回声	219（94.4%）	69（97.2%）	150（93.2%）
结节边缘				0.281
不规则	197（84.9%）	63（88.7%）	134（83.2%）
规则	35（15.1%）	8（11.3%）	27（16.8%）
微钙化				0.022
有	141（60.8%）	51（71.8%）	90（55.9%）
无	91（39.2%）	20（28.2%）	71（44.1%）
慧星尾征				1.000
有	0（0）	0（0）	0（0）
无	232（100%）	71（30.6%）	161（69.4%）
CDFI血流				0.004
丰富	25（10.8%）	14（19.7%）	11（6.8%）
非丰富	207（89.2%）	57（80.3%）	150（93.2%）
紧贴包膜				0.004
有	111（47.8%）	44（62.0%）	67（41.6%）
无	121（52.2%）	27（38.0%）	94（58.4%）
C-TIRADS分类				0.089
3	1（0.4%）	0（0）	1（0.4%）
4A	6（2.6%）	3（4.2%）	3（1.9%）
4B	47（20.3%）	8（11.3%）	39（24.2%）
4C	173（74.6%）	59（83.1%）	114（70.8%）
5	5（2.2%）	1（1.4%）	4（2.5%）

表1

表2

图1

图2

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