甲状腺微小乳头状癌超声特征及其预测颈部淋巴结转移风险的价值  

The sonographic characteristics of papillary thyroid microcarcinoma and its risk evaluation of cervical lymphatic metastasis

作　　者：孙彤[1] 田晶[1] 卓娜[1] 李辰运[1] 段清[1] 宋金雨 边璇 Sun Tong;Tian J ing;Zhuo Na;Li Chenyun;Duan Qing;Song Jinyu;Bian Xuan(Department of Ultrasound,the Second Hospital of Tianjin University,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院超声科,300211

出　　处：《中华超声影像学杂志》2018年第7期599-603,共5页Chinese Journal of Ultrasonography

摘　　要：目的探讨甲状腺微小乳头状癌（PTMC）的超声图像特征及高频超声术前预测PTMC颈部淋巴结转移的临床价值。方法回顾性分析行甲状腺部分或全部切除及颈部淋巴结清扫术，且术后病理证实为PTMC的358例患者的超声图像特征，按单灶及多灶、是否存在淋巴结转移、不同癌灶最大径分别进行分组比较，并进行单因素及Logistic回归分析。结果多灶PTMC较单灶更易出现癌结节彩色血流信号、回声不均匀、颈部淋巴结转移（均P〈0．05）。单因素分析显示多灶且癌灶总的最大径〉1cm、边缘不规整、形态不规则、存在微钙化、侵犯被膜是PTMC颈部淋巴结转移的危险因素（均P〈0．05）。Logistic回归分析显示多灶结节、侵犯被膜是PTMC发生淋巴结转移的独立危险因素，二者联合ROC曲线下面积为0.807。结论同时具有多灶和侵犯被膜超声特征时，PTMC发生颈部淋巴结转移的风险明显增高，可为超声评估PTMC颈部淋巴结转移风险提供一定的参考依据。Objective To investigate the sonographic characteristics of papillary thyroid microcareinoma（PTMC） and the preoperative prediction value for cervical lymphatic metastasis of PTMC. Methods Three hundred and fifty-eight PTMC patients who were confirmed by pathology and accepted partly or totally thyroidectomy and neck dissection were collected to analyze the sonographie characteristics, all patients were classified according to muhifoeal carcinoma nodules and solitary carcinoma nodules;cervical lymphatic metastasis or not;the maximum diameter of carcinoma nodules. Univariate analysis and Logistic regression analysis were used. Results Compared with solitary PTMC, multifocal PTMC was prone to emerge blood flow signals, heterogeneity, cervical lymphatic metastasis （all P 〈 0.05）. By univariate analysis, the risk factors of cervical lymphatic metastasis in PTMC were multifocal lesions and the total maximum diameter 〉 1 cm, irregular edge, irregular shape, microcalcification, capsular invasion （all P〈 0.05）. With Logistic regression analysis, the independent risk factors of cervical lymphatic metastasis in PTMC were multifocality and capsular invasion. Combining multifocality and capsular invasion, which area under the ROC（AUC） was 0. 807. Conclusions Combining multifoeality and capsular invasion significantly improves the risk of cervical lymphatic metastasis in PTMC by ultrasonography.

关 键 词：超声检查 甲状腺肿瘤 淋巴结转移 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]