摘要
目的:从超声特征联合肿瘤标志物方面探讨cN_(0)期甲状腺微小乳头状癌(PTMC)颈部淋巴结转移的危险因素。方法:回顾性分析经超声引导下穿刺病理证实的133例cN_(0)-PTMC患者的超声特征和肿瘤标志物。超声特征包括病灶数量(单灶和多灶)、纵横比、微钙化和甲状腺包膜完整性;肿瘤标志物包括Ki-67、Galectin-3和CD56。根据术后病理诊断是否有淋巴结转移,分为淋巴结转移组(60例)和无淋巴结转移组(73例)。采用χ^(2)检验及多因素logistic回归分析观察超声特征、肿瘤标志物与淋巴结转移的关系,并分析各危险因素预测淋巴结转移的敏感度、特异度和准确率。结果:χ^(2)检验和多因素logistic回归分析显示,多灶性、微钙化、包膜突破、Ki-67阳性、CD56阳性是PTMC发生颈部淋巴结转移的危险因素(χ^(2)=20.135,11.255,16.947,4.693,3.806;均P<0.05)。多灶性、包膜突破和CD56阳性对预测PTMC颈部淋巴结转移的特异度(分别为82.2%、79.5%、89.0%)和准确率(分别为69.9%、68.4%、66.2%)均较高。结论:多灶性、微钙化、包膜突破、CD56阳性、Ki-67阳性是cN_(0)-PTMC颈部淋巴结转移的危险因素;多灶性、包膜突破和CD56阳性对预测cN_(0)-PTMC淋巴结转移的特异度较高;建议符合多灶性、包膜突破和CD56阳性情况的cN_(0)-PTMC行病灶切除联合淋巴结清扫及术后超声定期检查颈部淋巴结。
Objective:To investigate the risk factors for cervical lymph node metastasis of papillary thyroid microcarcinoma(PTMC)in cN_(0) stage(cN_(0)-PTMC,no lymph node metastasis detected by ultrasound)in terms of ultrasound features combined with tumor markers.Methods:The clinical data of 133 patients of cN_(0)-PTMC were respectively analyzed.Ultrasound features included number of lesions(single and multiple),aspect ratio,microcalcification,and capsule integrity.Tumor markers including Ki-67,Galectin-3 and CD56 were detected by immunohistochemical staining.According to postoperative pathological diagnosis of lymph node metastasis,they were divided into the lymph node metastasis group(60 cases)and the non-metastasis group(73 cases).Chi-square and multivariate logistic regression were used to analyze the relationship between ultrasound features,tumor markers and lymph node metastasis.The sensitivity,specificity and accuracy of risk factors for lymph node metastasis were analyzed.Results:Chi-square and multivariate logistic regression supported that the multiple lesions,microcalcification,capsule breakthrough,Ki-67 and CD56 positive were the risk factors for cervical lymph node metastasis(χ^(2)=20.135,11.255,16.947,4.693,3.806,all P<0.05).The multiple lesions,capsule breakthrough and CD56 positive had the higher specificity(82.2%,79.5%,89.0%)and accuracy(69.9%,68.4%,66.2%)in predicting cervical lymph node metastasis.Conclusions:PTMC multiple lesions,microcalcification,capsule breakthrough,CD56 and Ki-67 positive are the risk factors for cervical lymph nodes metastasis,and the multiple lesions,capsule breakthrough and CD56 positive have the higher specificity.It is recommended that cN_(0)-PTMC patients with multiple lesions,capsule breakthrough,CD56 positive should be treated with surgical resection combined with the lymph node dissection and regular ultrasound examination for the cervical lymph nodes after surgery.
作者
林友国
魏剑婷
杨焱
LIN Youguo;WEI Jianting;YANG Yan(Department of Preventive Treatment of Disease,Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine,Fuzhou 350004,China.)
出处
《中国中西医结合影像学杂志》
2023年第2期140-144,共5页
Chinese Imaging Journal of Integrated Traditional and Western Medicine
基金
福建省教育厅中青年教师教育科研项目(JAT170277)。
关键词
cN_(0)-PTMC
肿瘤标志物
超声检查
淋巴结转移
危险因素
Clinical lymph node negative papillary thyroid microcarcinoma
Tumor marker
Ultrasonography
Lymph node metastasis
Risk factor
