CT征象联合临床特征对cN0期单发甲状腺乳头状癌中央组淋巴结转移的预测价值  

Predictive value of CT combined with clinical features in diagnosing central lymph node metastasis of papillary thyroid carcinoma in stage cN0

作　　者：李宁 舒艳艳[2] 韩志江[3] 

机构地区：[1]杭州市富阳区第一人民医院放射科,浙江杭州311400 [2]杭州市萧山区第一人民医院放射科,浙江杭州311200 [3]杭州市第一人民医院放射科杭州市甲状腺疾病诊治中心,浙江杭州310006

出　　处：《中国临床医学影像杂志》2016年第9期616-619,共4页Journal of China Clinic Medical Imaging

基　　金：2015年浙江省医药卫生计划项目(2015KYB293);2013年杭州市重大科技创新专项项目(20131813A08);2012年杭州市卫生科技计划项目(2012A020)

摘　　要：目的：探讨CT征象联合临床特征对颈淋巴结临床阴性（clinical stage NO，cNO）单发甲状腺乳头状癌（PTC）中央组淋巴结转移（CLNM）的预测价值。方法：回顾经手术和病理证实的390例cN0期单发PrrC的CT征象及临床特征，通过受试者工作特征（ROC）曲线确定PTC直径的阈值，采用单因素和多因素Logistic回归分析瘤体位置、甲状腺边缘接触、钙化、平扫边界、增强后边界、直径、年龄、性别与CLNM的关系，计算单个和多个风险因素联合在CLNM阳性中的敏感度和特异度。结果：390例cN0期单发PTC中，CLNM阳性和阴性分别为109例和281例。ROC曲线示直径=0．7cm时，约登指数最大。单因素分析表明甲状腺边缘接触、直径、年龄和性别与CLNM阳性相关，其中甲状腺边缘接触、直径〉0．7cm、年龄〈45岁和男性在CLNM中更常见（P〈0．05）。多因素Logistic回归分析进一步表明甲状腺边缘接触、年龄〈45岁和男性与CLNM阳性相关，而直径与CLNM无关。单个风险因素的敏感度和特异度分别为30％～85％和34％-83％，两个或三个风险因素联合的敏感度和特异度分别为12％～49％和74％～94％。结论：甲状腺边缘接触、年龄〈45岁和男性是CLNM阳性的独立风险因素，多个风险因素联合可显著提高术前诊断的特异度．为cN0期单发PTC中央组淋巴结清扫提供重要的依据。Objective： To investigate the predictive value of CT combined with clinical features in diagnosing central lymph node metastasis of papillary thyroid carcinoma in stage cN0. Methods： The CT signs and clinical features of 390 cases of PTC confirmed by surgery and pathology were reviewed. The threshold of PTC diameter was identified by ROC. The location of tumor, thyroid edge contact, calcification, boundary on plain scan, boundary on enhanced scan, diameter, age, gender and relation with CLNM were analyzed by univariate and multivariate logistic regression method. The sensitivity and specificity of single factor and combined multiple risk factors in positive CLNM were calculated. Results： Among 390 cases of PTC in stage cN0, there were 109 cases of CLNM positive and 281 cases of CLNM negative. ROC curve showed that when the diameter=0.7 cm, the Youden index is maximum. Univariate analysis indicated that thyroid edge contact, diameter, age and gender were correlated with CLNM positive, of which, thyroid edge contact, diameter 〉0.7 cm, age 〈45 years and men were more common in CLNM （P〈0.05）. Multivariate logistic regression analysis further indicated that thyroid edge contact, age 〈45 years and men were associated with CLNM positive, while diameter was not associated with CLNM. The sensitivity and specificity of individual risk factor were 30%-85% and 34%-83% respectively. The sensitivity and specificity of combination of two or more risk factors were 12%-49% and 74%-94%, respectively. Conclusion： The individual risk factors of CLNM positive are thyroid edge contact, age 〈45 years, and men. The combination of multiple risk factors can significantly enhance the specificity of preoperative diagnosis, providing important basis for lymphadenectomy of PTC in stage cN0.

关 键 词：甲状腺肿瘤 癌 乳头状 淋巴转移 体层摄影术 螺旋计算机 

分 类 号：R736.1[医药卫生—肿瘤] R730.261[医药卫生—临床医学]