超声诊断甲状腺微小乳头状癌腺外侵犯的影响因素分析  

Analysis of the influence factors on ultrasound diagnosis of extrathyroidal extensions in papillary thyroid microcarcinoma

作　　者：王娴[1] 谌业荣[2] 张国梁[3] 张津[1] 张衡[2] 钱晓芹[1] 胡曙东 WANG Xian;CHEN Yerong;ZHANG Guoliang;ZHANG Jin;ZHANG Heng;QIAN Xiaoqin;HU Shudong(Department of Ultrasound,the Affiliated Renmin Hospital,Jiangsu University,Jiangsu 212002,China)

机构地区：[1]江苏大学附属人民医院超声科,江苏省无锡市212002 [2]江苏大学附属人民医院影像科,江苏省无锡市212002 [3]江苏大学附属人民医院普外科,江苏省无锡市212002 [4]江南大学附属医院影像科

出　　处：《临床超声医学杂志》2020年第6期407-410,共4页Journal of Clinical Ultrasound in Medicine

基　　金：国家自然科学基金项目(81771848)。

摘　　要：目的探讨甲状腺微小乳头状癌(PTMC)的超声特征与甲状腺外侵犯假阴性、假阳性的相关因素。方法收集术前行超声检查的PTMC患者326例,共472枚结节。以术后病理结果为金标准,计算超声评估PTMC腺外侵犯的敏感性、特异性、阳性预测值、阴性预测值、准确率,分析其超声待征与假阴性、假阳性的相关性。结果472枚PTMC结节术后病理诊断141枚甲状腺外侵犯,超声诊断真阳性73枚,假阴性68枚,其诊断腺外侵犯的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为51.7%、86.7%、62.4%、80.8%及76.3%;单因素分析结果显示,结节直径≤5 mm、纵横径比≥1、邻近气管、双侧叶病变与假阴性相关(均P<0.05);多因素分析结果显示,邻近气管和双侧叶病变是假阴性的独立危险因素(OR=4.916、7.237,均P<0.05)。余331枚无甲状腺外侵犯的PTMC病灶中,超声诊断真阴性287枚,假阳性44枚;单因素分析结果显示结节直径≤5 mm与假阳性相关(P<0.05)。结论PTMC原发病灶超声特点如大小、形状、部位是影响PTMC腺外侵犯诊断结果的重要因素。Objective To assess the ultrasonographic features and the influence factors that affect the false-negative(FN),false-positive(FP)diagnosis of extrathyroidal extensions(ETE)in papillary thyroid microcarcinoma(PTMC).Methods The preoperative ultrasonic data of 472 nodules in 326 patients with PTMC confirmed by pathology were collected and analyzed.Taken pathological results as golden standard,the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and accuracy of ultrasound in evaluation of ETE were calculated.The factors associated with FN and FP for ETE were analyzed.Results There were 141 PTMC lesions with extrathyroidal extensions,73 lesions were true-positive and 68 were FN.The sensitivity,specificity,PPV,NPV and accuracy of ultrasoud in predicting ETE were 51.7%,86.7%,62.4%,80.8%and 76.3%,respectively.The univariate analysis showed that diameter of tumor≤5 mm,aspect ratio≥1,vicinity of the trachea(non-adjacent)and bilateral lobes lesions were associated with FN(all P<0.05).Multiple Logistic regression analysis showed that vicinity of the trachea(non-adjacent),bilateral lobes lesions were independent risk factors for FN(OR=4.916,7.237,both P<0.05).The rest 331 PTMC lesions without extrathyroidal extensions,287 were true-negative for ultrasound diagnosis and 44 were FP,univariate analysis showed that diameter of tumor≤5 mm was associated with FP.Conclusion Sonographic features of the lesions,such as diameter,shape and location are important factors to affect the diagnosis of ETE in PTMC.

关 键 词：超声检查 乳头状癌 甲状腺 甲状腺外侵犯 假阴性 假阳性 

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]