甲状腺微小乳头状癌中央区颈部淋巴结转移风险评分系统的初步构建  

Preliminary construction of risk scoring system for estimation of central cervical lymph node metastasis in papillary thyroid microcarcinoma

作　　者：马文卿 周平[1] 梁永平 田双明[1] 赵永锋[1] 刘稳刚[1] MA Wenqing;ZHOU Ping;LIANG Yongping;TIAN Shuangming;ZHAO Yongfeng;LIU Wengang(Department of Ultrasonic Examination, the Third Xiangya Hospital, Central South University, Changsha 410013, China)

机构地区：[1]中南大学湘雅三医院超声科,湖南长沙410013

出　　处：《中国普通外科杂志》2018年第6期752-760,共9页China Journal of General Surgery

基　　金：湖南省科技厅科技计划资助项目(2014SK3245)

摘　　要：目的:探讨通过甲状腺微小乳头状癌(PTMC)结节的超声图像特征与患者临床资料构建中央区颈部淋巴结转移的预测模型。方法:收集121例手术与病理确诊为PTMC患者的临床资料及其166个结节的超声图像,通过统计学方法分析找出中央区颈部淋巴结转移相关因素,分别建立中央区颈部淋巴结转移风险预测的Logistic评分模型与Additive评分模型。结果:统计结果显示,年龄、结节多灶性、结节大小、结节与甲状腺包膜的关系、超声造影结节周边增强情况与中央区颈部淋巴结转移风险有关(均P<0.05);将以上因素进行赋值评分;所得总分以ROC曲线下面积(AUC)评价,当Logistic模型得分为6.5分时,AUC为0.964、敏感性98.4%、特异性74.1%;当Additive模型得分为33.5分时,AUC为0.928、敏感性88.9%、特异性84.5%;HosmerLemeshow拟合优度检验示Logistic模型拟合较好。结论:所构建的Logistic模型对PTMC中央区颈部淋巴结转移有较好的预测价值,可为PTMC治疗方案的选择提供量化依据,其分值≥7分时,需高度怀疑存在中央区颈部淋巴结转移的可能,反之,转移可能性较小。Objective： To investigate the construction of a predictive model for estimation of central cervical lymph node metastasis of papillary thyroid microcarcinoma （PTMC） based on the ultrasonographic features of the nodules and clinical data of the patients. Methods： The clinical data of 121 patients with PTMC that was confirmed by surgical and pathological findings and their ultrasonic images of 166 thyroid nodules were collected. The relevant factors for central cervical lymph node metastasis were analyzed and picked up by statistical methods, and then, the Logistic and Additive scoring models for estimating risk of central cervical lymph node metastasis were established, respectively. Results： The results of statistical analyses showed that age, multifocal lesion, nodule size, relationship between nodule and thyroid capsule, and imaging feature of perinodular enhancement were closely related to the risk of central cervical lymph node metastasis （all P〈0.05）. These factors were numerically assigned and scored. According to the total score evaluated by the area under the ROC curve （AUC）, when the score derived from the Logistic model reached 6.5, the AUC was 0.964 with a sensitivity of 98.4% and a specificity of 74.1%; when the score derived from Additive model reached 33.5, the AUC was 0.928 with a sensitivity of 88.9% and a specificity of 84.5%. Hosmer-Lemeshow goodness of fit test indicated that Logistic model had a better fit. Conclusion： The constructed Logistic model has certain predictive value for estimating risk of central cervical lymph node metastasis in PTMC, and it can provide a quantitative basis for the treatment plan selection of PTMC. When its score is equal to or greater than 7, the possibility of central cervical lymph node metastasis should be highly suspected.

关 键 词：甲状腺肿瘤 癌 乳头状 淋巴转移 超声检查 危险性评估 

分 类 号：R736.1[医药卫生—肿瘤]