摘要
目的探讨超声术前评估甲状腺乳头状癌复发风险分层对临床诊疗的价值。方法回顾性分析2017年1–12月期间在四川大学华西医院进行手术切除且术后病理学检查证实为甲状腺乳头状癌的400例患者(400个病灶)的临床资料,评价超声复发风险评级与术后临床复发风险分层的一致性。结果 400个病灶中,病灶直径为(12.8±8.5)mm,其中≤10 mm的病灶214个,10～40 mm的病灶178个,>40 mm的病灶8个。发生淋巴结转移242例,出现被膜侵犯309例。临床复发风险分层:低危224个,中危148个,高危28个。超声复发风险分层:低危111个,中危270个,高危19个。术后复发风险分层和术前超声复发风险分层的一致性中等(κ=0.414,P<0.01)。此外,超声检查与临床对于淋巴结转移的一致性较差(κ=0.291,P<0.05),对于被膜侵犯判断的一致性中等(κ=0.402,P<0.05)。结论甲状腺超声术前评估复发风险分层,侧重于个体化的术前评估,评估内容更加详细和细致,一定程度上有助于后续治疗及早期筛查复发风险。
Objective To evaluate the value of preoperative risk assessment of papillary thyroid carcinoma with ultrasound for clinic diagnosis and treatment.Methods The data of 400 patients with papillary thyroid carcinoma received operative treatment in 2017 were retrospectively analyzed.Recorded and analyzed the ultrasonic risk assessment and postoperative grading of clinic risk assessment,to evaluate coherence and correlation between them.Results There were 400lesions with an average size of (12.8±8.5)mm.Among 400 lesions,diameter of 214 lesions less than 10mm, diameter of 178 lesions were between 10mm and 40mm,and diameter of 8lesions were larger than 40mm.A total of 242 cases had lymph node metastasis and 309 cases had capsule invasion.Clinical and ultrasoud risk assessment was performed on 400 lesions.There were 224 lesions with low risk of clinical risk stratification vs.111 lesions with low ultrasonic risk,148 lesions with intermediate risk of clinical risk stratification vs.270 lesions with intermediate ultrasonic risk,and 28 lesions with high risk of clinical risk stratification vs.19 lesions with high ultrasonic risk.The consistency of postoperative recurrence risk stratification and preoperative ultrasound recurrence risk stratification was moderate (κ=0.414,P<0.01).In addition,the consistency between ultrasound examination and clinical lymph node metastasis was poor (κ=0.291,P<0.05),and the consistency of invasion of the capsule was moderate (κ=0.402,P<0.05).Conclusion Preoperative evaluation of recurrence risk grading before thyroid ultrasound,focusing on individualized preoperative assessment,the assessment is more detailed and detailed,and is helpful for follow-up treatment and early screening for recurrence risk.
作者
何玉霜
马步云
彭玉兰
周洁宏
HE Yushuang;MA Buyun;PENG Yulan;ZHOU Jiehong(Department of Ultrasound,West China Hospital of Sichuan University,Chengdu 610041,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2018年第12期1476-1481,共6页
Chinese Journal of Bases and Clinics In General Surgery
关键词
甲状腺乳头状癌
超声诊断
术前诊断
风险分层
papillary thyroid carcinoma
ultrasonic diagnosis
preoperative diagnosis
risk grading
