摘要
目的探讨CT强化程度对甲状腺乳头状癌(papillary thyrroid carcinoma,PTC)颈部淋巴结转移的诊断价值。方法回顾分析经手术病理证实的251例PTC中535枚颈部淋巴结的CT资料,计算CT增强与平扫密度值的比值和差值,采用Mann-Whitney检验分析比值和差值在淋巴结转移组和非转移组中的分布,通过受试者工作特异度曲线(ROC)获得比值和差值在两组中的最佳阈值。结果535枚颈部淋巴结中,包括转移组271枚和非转移组264枚,两组的比值分别为2.30(2.04,2.76)和1.66(1.51,1.81)(Z=-16.94,P<0.05),差值分别为58(49,76)Hu和31(22,36)Hu(Z=-18.045,P<0.05)。两组比值和差值的ROC曲线下面积分别为0.923和0.951,最佳阈值分别为1.93和39.5 Hu,诊断淋巴结转移的敏感度和特异度分别为84.9%和87.1%、91.5%和86.0%。两者联合诊断淋巴结转移的敏感度和特异度为82.3%和91.7%。结论增强与平扫密度值的比值≥1.93和差值≥39.5 Hu对PTC颈部淋巴结转移具有较高的诊断效能,两者的特异度相仿,后者具有更高的敏感度,两者联合可明显提高特异度,从而减少不必要的手术创伤。
Objective To investigate the value of CT enhancement degree in diagnosing cervical lymph node metastasis of papillary thyroid carcinoma(PTC).Methods CT data of 535 neck lymph nodes with pathological diagnosis in 251 cases were retrospectively analyzed.The ratio and difference between the density of CT enhancement and plain scan were calculated.Mann-Whitney test was used to analyze the distribution of ratio and difference in lymph node metastasis group and non-metastasis group.The optimal thresholds of ratio and difference in the two groups were obtained by receiver operating characteristic(ROC)curve analysis.Results 535 cervical lymph nodes including 271 in metastatic group and 264 in non-metastatic group.The ratios of two groups were 2.30(2.04,2.76)and 1.66(1.51,1.81)(Z=-16.94,P<0.05)respectively,and the differences were 58(49,76)Hu and 31(22,36)Hu(Z=-18.045,P<0.05)respectively.When the ROC area under curve of ratio and difference between the two groups were 0.923 and 0.951 respectively,the optimal thresholds were 1.93 and 39.5Hu respectively.The sensitivity and specificity of diagnosing lymph node metastasis were 84.9%and 87.1%、91.5%and 86.0%respectively.The sensitivity and specificity of combination of the two diagnosing lymph node metastasis were 82.3%and 91.7%.Conclusions The ratio of enhancement and plain scan density≥1.93 and the difference≥39.5Hu have a high diagnostic efficiency for cervical lymph node metastasis of PTC.The specificity of the two is similar,but the latter has higher sensitivity.The combination of the two can significantly improve the specificity,thereby reducing unnecessary surgical trauma.
作者
魏培英
蒋念东
韩志江
王海滨
丁金旺
Wei Peiying;Jiang Niandong;Han Zhijiang;Wang Haibin;Ding Jinwang(Department of Radiology,Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China;Department of Radiology,Chunan County Hospital of Traditional Chinese Medicine,Hangzhou 311700,China;Department of Surgical Oncology,Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China)
出处
《中华内分泌外科杂志》
CAS
2020年第2期144-148,共5页
Chinese Journal of Endocrine Surgery
基金
浙江省医药卫生科技项目(2020369811)
杭州市社会发展自主申报项目(20180533B39)
浙江省公益技术应用研究项目(2017C33180)
杭州市重大科技创新专项项目(20131813A08)。
