摘要
目的观察联合应用甲状腺乳头状癌(PTC)临床、超声及病理特征判断其Delphian淋巴结转移(DLNM)的价值。方法纳入358例接受甲状腺根治性切除术的PTC患者,根据术后病理显示DLNM状态分为阳性组(n=92)和阴性组(n=266);以单因素及多因素分析比较2组术前临床、超声和术后病理特征并建立模型,观察各模型诊断DLNM的价值。结果基于临床+超声特征,男性、年龄≥45岁、双侧甲状腺受累,肿瘤超声形态不规则、甲状腺外侵犯(ETE)和颈部中央淋巴结转移(CLNM)是PTC DLNM的危险因素;PTC位于下极和峡部、伴结节性甲状腺肿为其保护因素。基于临床+病理特征,男性、年龄≥45岁、双侧甲状腺受累,病理学ETE(P-ETE)及CLNM是PTC DLNM的危险因素;PTC位于甲状腺下极和峡部、伴结节性甲状腺肿为其保护因素。基于临床+超声+病理特征,男性、年龄≥45岁、双侧甲状腺受累,超声显示肿瘤不规则形态、ETE和病理显示CLNM均为PTC DLNM的危险因素,而PTC位于下极和峡部、伴结节性甲状腺肿为保护因素。基于上述结果分别建立临床+超声、临床+病理和临床+超声+病理模型,其诊断PTC DLNM的曲线下面积(AUC)分别为0.823、0.732和0.856,以临床+超声+病理模型的AUC最高,且与临床+病理模型AUC差异有统计学意义(P<0.01)。结论联合应用PTC临床、超声及病理特征有助于判断其DLNM。
Objective To observe the value of combination of clinical,ultrasonic and pathological features for diagnosing Delphian lymph node metastasis(DLNM)of papillary thyroid carcinoma(PTC).Methods A total of 358 PTC patients who underwent radical thyroidectomy were enrolled and divided into positive group(n=92)and negative group(n=266)according to pathological findings of DLNM.Preoperative clinical,ultrasonic and postoperative pathological features were compared between groups using univariate and multivariate analysis.Then relative models were established,and the value of each model for diagnosing DLNM was analyzed.Results Based on clinical+ultrasonic features,male,age≥45 years old,bilateral involvement,PTC with irregular ultrasonic morphology,ultrasonic extrathyroidal extension(ETE)and ultrasound cervical central lymph node metastasis(CLNM)were risk factors,while lower pole or isthmus PTC and complicated with nodular goiter were protective factors of PTC DLNM.Based on clinical+pathological features,male,age≥45 years old,bilateral involvement,pathology ETE(P-ETE)and pathological CLNM were risk factors,while lower pole or isthmus PTC and complicated with nodular goiter were protective factors of PTC DLNM.Based on clinical+ultrasonic+pathological features,male,age≥45 years old,bilateral involvement,irregular ultrasonic morphology PTC,ultrasonic ETE and pathological CLNM were risk factors,while lower pole oristhmus PTC and compicated with nodular goiter were protective factors of PTC DLNM.Finally clinical+ultrasonic,clinical+pathological and clinical+ultrasonic+pathological model were established,and the area under the curve(AUC)for diagnosing PTC DLNM was 0.823,0.732 and 0.856,respectively.The AUC of clinical+ultrasonic+pathological model was the highest,which was of significant difference with that of clinical+pathological model(P<0.01).Conclusion Combination of clinical,ultrasonic and pathological features were helpful for diagnosing PTC DLNM.
作者
曹皎皎
陈小敏
贾红靖
马丽媛
陆冰
马蕾
CAO Jiaojiao;CHEN Xiaomin;JIA Hongjing;MA Liyuan;LU Bing;MA Lei(Department of Ultrasound,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou 215002,China;Department of Ultrasound,Dushuhu Public Hospital Affiliated to Soochow University,Suzhou 215124,China)
出处
《中国介入影像与治疗学》
北大核心
2023年第11期675-679,共5页
Chinese Journal of Interventional Imaging and Therapy
关键词
甲状腺癌
乳头状
淋巴结转移
超声检查
病理学
thyroid cancer,papillary
lymphatic metastasis
ultrasonography
pathology
