摘要
目的:通过回顾性分析单灶甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的超声声像特征,寻找单灶PTC颈部淋巴结转移的相关高危因素,总结单灶PTC颈部淋巴结转移规律,从而提高单灶PTC颈部淋巴结的超声检出率,用以指导临床对单灶PTC颈部淋巴结清扫手术方式的选择。方法:回顾性分析2018年1月至2020年1月于我院行甲状腺癌手术且术后病理证实为单灶PTC的95例患者,分析病灶的超声声像特征,并探讨影响PTC颈部淋巴结转移的因素。结果:肿瘤所在长轴方位与淋巴结转移区域的相关性有统计学意义(P=0.025)。位于侧叶下部的肿瘤可局限于下极周围中央区淋巴结转移,少部分并发同侧颈侧区淋巴结转移;上中部区域的肿瘤如果发生淋巴结转移,则多数为同侧颈侧区淋巴结转移合并中央区上极周围淋巴结转移,但中央区淋巴结术前超声发现率较低。不同肿瘤大小的病理淋巴结转移区域的差异有统计学意义(P<0.001)。建立模型预测术前淋巴结转移的风险发现,当肿瘤大小取最大直径时,ROC曲线截断值为9,即肿瘤最大直径>9 mm时有统计学意义(P<0.05)。结论:根据单灶PTC淋巴结转移规律,当肿瘤最大直径>9 mm、肿瘤位于下部时,增加了超声医师提示可疑中央区淋巴结转移的依据,有望提高中央区转移淋巴结的检出率。对单灶PTC在超声声像图中肿瘤最大直径>9 mm、肿瘤位于下部时临床可以考虑行中央区淋巴结清扫,为颈部淋巴结清扫术的选择及淋巴结清扫范围提供了一定的根据。
Objective:To explore the high risk factors of solitary papillary thyroid carcinoma(PTC)with lymph node metastasis(LNM)and summarize the mechanism of LNM in solitary PTC by retrospectively analyzing the imaging charac-teristics of solitary PTC,so as to improve the ultrasonic detection rate of metastatic lymph nodes in solitary PTC and help select the operation methods of cervical lymph node dissection for solitary PTC patients.Methods:Retrospective analysis was performed on 95 cases of thyroid cancer operated in our hospital from January 2018 to July 2019 and confirmed to be solitary PTC by postoperative pathology.Sonographic features of the lesions were analyzed,and factors affecting cervical LNM in PTC were discussed.Results:The location of the tumor on the long axis was correlated to the metastatic region(P=0.025).Tumors located in the lower part of lateral lobes were apt to transfer to lymph nodes in the central region around the lower pole of a thyroid gland,only a few of them are complicated with ipsilateral cervical LNM.LNM in the upper-middle region mostly occurred in the central region around the upper pole of a thyroid gland and the ipsilateral neck region,and the preoperative ultrasound detection rate of lymph nodes in central region was low.LNM sites of tumors in different sizes were compared,and difference was significant(P<0.001).A model established for predicting the risk of LNM before surgery revealed that the maximum tumor diameter was positively correlated to the risk of LNM when the ROC curve cut-off value was 9(P<0.05),which means there was a risk of LNM when maximum tumor diameter was greater than 9 mm.Conclusion:According to the rule of LNM in solitary PTC,maximum tumor diameter>9 mm and tumor located in the lower part of the thyroid gland are relatively reliable evidence for LNM in central region,which helps to improve the detection rate of metastatic lymph nodes in the central region and indicates central lymph node dissection.
作者
许晓华
苏琳
贾丹
贾亦真
李萍
谢婷
邢志金
黄志恒
刘力
江孟勋
江将
Xu Xiaohua;Su Lin;Jia Dan;Jia Yizhen;Li Ping;Xie Ting;Xing Zhijin;Huang Zhiheng;Liu Li;Jiang Mengxun;Jiang Jiang(Department of Ultrasound,the University of Hong Kong-Shenzhen Hospital,518000 Shenzhen,Guangdong,China;Department of Core Laboratory,the University of Hong Kong-Shenzhen Hospital,51800 Shenzhen,Guangdong,China;Department of Pathology,the University of Hong Kong-Shenzhen Hospital,518000 Shenzhen,Guangdong,China;Department of Endocrine Surgery,the University of Hong Kong-Shenzhen Hospital,518000 Shenzhen,Guangdong,China)
出处
《肿瘤预防与治疗》
2020年第11期841-847,共7页
Journal of Cancer Control And Treatment
基金
深圳市科技创新委员会基金(编号:JCYJ20160429185900035)。
关键词
单灶甲状腺乳头状癌
超声检查
淋巴结转移
Solitary papillary thyroid carcinoma
Ultrasonography
Lymph node metastasis
