CT增强联合甲状腺球蛋白及抗体在甲状腺乳头状癌颈部淋巴结转移中的预测价值  

The Value of CT Enhancement Combined with Thyroglobulin and Antibody in Predicting Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma

作　　者：徐海燕[1] 潘景润 宫希军[1] 王龙胜[1] XU Hai-yan;PAN Jing-run;GONG Xi-jun;WANG Long-sheng(Department of Radiology,the Second Affiliated Hospital of Anhui Medical University,Hefei 230031,Anhui,China)

机构地区：[1]安徽医科大学第二附属医院放射科,安徽合肥230031

出　　处：《医学信息》2021年第20期119-121,128,共4页Journal of Medical Information

摘　　要：目的探讨CT增强、甲状腺球蛋白及抗体在诊断甲状腺乳头状癌及预测颈部淋巴结转移中的价值,为提高甲状腺癌检出率,提供最佳诊疗方案。方法收集2019年1月-2020年12月在我院行甲状腺CT增强检查且经病理证实的甲状腺乳头状癌患者的CT增强征象,包括钙化、增强后边缘是否变模糊、甲状腺边缘是否中断),术前甲状腺球蛋白及抗体指标,是否有淋巴结转移;分析CT增强征象、甲状腺球蛋白及抗体对颈部淋巴结转移阳性预测的敏感度、特异度、阳性预测值、阴性预测值。结果261例甲状腺乳头状癌病灶中,含有钙化的占42.15%,其中含细小钙化的占75.45%,含粗大钙化的占24.55%;增强后病灶边缘变模糊占90.81%;甲状腺轮廓中断的占54.41%;甲状腺球蛋白阳性的占12.64%;甲状腺球蛋白抗体阳性的占21.07%;术后淋巴结清扫中有淋巴结转移占60.54%。单个风险因素中,增强后病灶边缘变模糊的敏感度(92.40%)最高,甲状腺球蛋白阳性的特异度最高(86.40%)。结论甲状腺乳头状癌发病率高,虽具有一定惰性生物学行为,但颈部淋巴结转移率高,识别CT征象有助于提高甲状腺乳头状癌的诊断正确率,且结合甲状腺球蛋白水平有助于预测淋巴结转移的价值,进一步为治疗方式的选择患者预后判断提供参考。Objective To investigate the value of CT enhancement,thyroglobulin and antibody in the diagnosis of papillary thyroid carcinoma and prediction of cervical lymph node metastasis,and to provide the best diagnosis and treatment plan for improving the detection rate of thyroid carcinoma.Methods The CT enhancement signs of patients with papillary thyroid carcinoma confirmed by pathology who underwent thyroid CT enhancement examination in our hospital from January 2019 to December 2020 were collected,including calcification,blurred edges after enhancement,interruption of thyroid edges,preoperative thyroglobulin and antibody indexes,and lymph node metastasis.The sensitivity,specificity,positive predictive value and negative predictive value of CT enhancement signs,thyroglobulin and antibody for positive prediction of cervical lymph node metastasis were analyzed.Results Among 261 cases of papillary thyroid carcinoma,42.15%contained calcification,75.45%contained fine calcification,and 24.55%contained coarse calcification.The edge of lesions became blurred after enhancement accounted for 90.81%;thyroid contour interruption accounted for 54.41%;thyroid globulin positive accounted for 12.64%;thyroid globulin antibody positive accounted for 21.07%;lymph node metastasis in postoperative lymph node dissection accounted for 60.54%.Among the single risk factors,the sensitivity(92.40%)of lesion edge blurring after enhancement was the highest,and the specificity of thyroglobulin positive was the highest(86.40%).Conclusion The incidence of papillary thyroid carcinoma is high.Although it has a certain inert biological behavior,the cervical lymph node metastasis rate is high.The identification of CT signs is helpful to improve the diagnostic accuracy of papillary thyroid carcinoma,and the combination of thyroid globulin level is helpful to predict the value of lymph node metastasis,which can further provide reference for the prognosis judgment of patients with the choice of treatment methods.

关 键 词：甲状腺乳头状癌 体层摄影术 X线计算机 甲状腺球蛋白及抗体 淋巴结转移 

分 类 号：R817[医药卫生—影像医学与核医学]