甲状腺乳头状癌颈侧区淋巴结转移的危险因素及影像诊断价值评估  

Risk factors and imaging diagnostic value of cervical lymph node metastasis in papillary thyroid carcinoma

作　　者：傅迎霞 张羽[1] 朱红 马丙娥[2] 彭飞[1] 王建华[2] 张宗军 FU Yingxia;ZHANG Yu;ZHU Hong;MA Binge;PENG Fei;WANG Jianhua;ZHANG Zongjun(Department of Radiology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine, Nanjing 210028, P.R.China;Thyroid and Breast Surgical Department, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine, Nanjing 210028, P.R.China)

机构地区：[1]南京中医药大学附属中西医结合医院放射科,江苏南京210028 [2]南京中医药大学附属中西医结合医院甲乳外科,江苏南京210028

出　　处：《医学影像学杂志》2021年第8期1287-1292,共6页Journal of Medical Imaging

基　　金：江苏省卫生健康委科研课题项目(编号:BJ18029)。

摘　　要：目的探讨甲状腺乳头状癌(PTC)颈侧区淋巴结转移的危险因素,CT、超声检查对PTC颈侧区淋巴结转移的预测价值。方法选取并分析我院2016年1月~2019年11月经手术病理证实的430例PTC患者的临床及影像学资料,根据病理结果分为颈侧区淋巴结转移阳性组106例与转移阴性组324例。通过单因素卡方检验和多因素logistics回归分析其与患者年龄、性别、病灶位置、直径、包膜侵犯、多灶、伴有慢性淋巴细胞性甲状腺炎以及侧颈部各区域转移情况等临床影像特征之间的相关性。对CT、超声检查采用受试者工作特征(ROC)曲线、敏感性和特异性来判断诊断价值。结果单因素分析表明,病灶直径大于1 cm、位于甲状腺上极、包膜侵犯及合并中央区淋巴结转移者易发生颈侧区淋巴结转移;多因素logistics回归进一步分析表明病灶位于甲状腺上极、包膜侵犯、合并中央区淋巴结转移是PTC颈侧区淋巴结转移的独立危险因素。CT联合超声检查诊断的敏感性93.4%,特异性88.8%,ROC曲线下面积0.911、约登指数0.823,诊断效能最高。结论当病灶位于甲状腺上极、包膜受侵犯,合并中央区淋巴结转移时,临床应高度怀疑PTC颈侧区淋巴节转移;CT联合超声检查可以明显提高颈侧区淋巴结的检出率。Objective To investigate the risk factors of lateral cervical lymph node metastasis of papillary thyroid carcinoma(PTC)by analyzing the image and clinical features of cervical lymph node metastasis of PTC,and to discuss the predictive value of CT and B-ultrasound in lateral cervical lymph node metastasis of PTC.Methods The image and clinical data of 430 patients with PTC confirmed by operation in our hospital from January 2016 to November 2019 were analyzed retrospectively.According to the pathological results,they were divided into two groups,lateral cervical lymph node metastasis positive group(106 cases),and metastasis negative group(324 cases).By single factor chi square test and multi factor Logistic regression analysis,the correlation between them and the clinical imaging characteristics of patients,such as age,gender,focus location,diameter,capsule invasion,multi focus,with chronic lymphocytic thyroiditis and metastasis of each region in the lateral neck,was studied.The ROC curve,sensitivity and specificity were used to determine the diagnostic value of CT and B ultrasound.Results Single factor analysis showed the lesion diameter greater than 1 cm,located in the upper pole of the thyroid gland,capsule invasion and lymph node metastasis in the central region were prone to lateral cervical lymph node metastasis.Multi factor logistic regression analysis showed that the lesions located in the upper pole,capsular invasion,and central lymph node metastasis was an independent risk factor for lateral cervical lymph node metastasis of PTC.The diagnosis sensitivity of CT combined with B-ultrasound was 93%,the specificity was 88.8%,the area under the ROC curve was 0.911,the Jordan index was 0.823,which had the highest diagnostic efficacy.Conclusion When the focus is located in the superior,thyroid capsule invasion,combined with central lymph node metastasis,PTC lateral cervical lymph node metastasis should be highly suspected.CT combined with B ultrasonic examination can significantly improve the detection rate of la

关 键 词：甲状腺乳头状癌 颈侧区淋巴结 转移 体层摄影术 X线计算机 彩色多普勒 

分 类 号：R736.1[医药卫生—肿瘤] R445[医药卫生—临床医学]