摘要
目的评价高分辨率超声(US)对甲状腺微小乳头状癌(PTMC)甲状腺外侵犯的诊断价值。方法对180例(216个结节)经手术病理证实的直径≤1cm的甲状腺乳头状癌患者的超声表现进行了研究,根据结节与临近甲状腺被膜的接触程度判断其是否存在甲状腺外侵犯。对与被膜有接触的结节根据接触的程度分为4级,分别为a级:与相邻的甲状腺被膜有密切接触;b级:结节与相邻的甲状腺被膜接触面积≥20%;c级:结节与相邻的甲状腺被膜接触面积≥40%;d级:结节破坏相邻的甲状腺被膜。通过与手术病理结果对照分析,计算每各级对甲状腺癌甲状腺外侵犯的灵敏度、特异度、预期值及ROC曲线下面积。结果 216个结节中经手术病理证实为发生甲状腺外侵犯的共87个(40.3%),超声发现与甲状腺被膜有接触的111个中,经病理证实发生侵犯的结节有70个(63.1%);与相邻的甲状腺被膜未发生接触的105个结节中,经证实有88个(83.8%)未发生甲状腺外侵犯,两者之间的差别具有统计学意义(P<0.001)。PTMC与相邻被膜密切接触、接触面积≥20%、≥40%及破坏被膜组的Az值分别为0.640、0.656、0.470、0.479。结论高分辨超声观察甲状腺乳头状癌与相邻甲状腺包膜密切接触可作为PTMC甲状腺外侵犯的重要依据,当PTMC与甲状腺包膜接触面积≥20%时对判断其甲状腺外侵犯更有意义。
Objective To evaluate the diagnostic value of high-resolution ultrasound （US） for predicting the extrathyroid extension of papillary thyroid microcarcinoma （PTMC）. Methods One hundred and eighty patients （216 nodules） of PTMC confirmd by surgical operation and pathologic examination were studied. According to the ultrasound findings, the PTMC nodules contact with the adjacent thyroid capsule were divided into four-grade, grade A： the nodules contacting with the adjacent thyroid capsule, grade B ： the contact area ≥ 20% , grade C ： the contact area ≥ 40% , grade D ： adjacent capsule was disrupted. The snsitivity, specificity, predictive value and the area under the ROC curve were calculated respectively. Results In all the 216 nodules, 87 （40.3 % ） nodules were diagnosed with extrathyroid extension by surgical operation and pathogic examination. Of the 111 nodules that were in contact with the adjacent capsule on US, 70 （63. 1% ） were extrathyroid extension after pathology. Of the 105 cancers that had no contact with the adjacent capsule on US, 88 （83.8%） were without extrathyroid extension after pathology. The difference was statistically significant （ P 〈 0. 001 ）. More than 20% contact with the adjacent capsule （Az =0.656） was the most accurate index for predicting extrathyroidal extension compared with Contacting with the adjacent capsule （ Az = 0. 640 ）, more than 40% contact with the adjacent capsule （ Az = 0. 470） and disruption at the adjacent capsule （ Az = 0.479）. Conclusion The presence and degree of contact between a PTMC nodule and the adjacent capsule as found by US examination can pro vide an important information to predict the extrathyroid extension before surgical operation. The present of more than 20% contact can be a useful mark.
出处
《医学影像学杂志》
2016年第12期2208-2211,共4页
Journal of Medical Imaging
关键词
甲状腺微小乳头状癌
甲状腺外侵犯
高分辨率超声
Papillary thyroid microcarcinoma（FFMC）
Extrathyroid extension
High-resolution ultrasound
