甲状腺微小乳头状癌超声特征联合TSH检测对颈侧淋巴结转移的预测作用分析  

ANALYSIS OF PREDICTIVE EFFECT OF ULTRASONIC FEATURES OF THYROID PAPILLARY MICROCARCINOMA COMBINED WITH TSH DETECTION ON CERVICAL LYMPH NODE METASTASIS

作　　者：刘小女 雷敏 胡青青 露娜 LIU Xiaonv;LEI Min;HU Qingqing;LU Na(Department of Ultrasound,Ganzi Tibetan Autonomous Prefecture People’s Hospital,Ganzi 626000,China)

机构地区：[1]四川省甘孜藏族自治州人民医院超声科,626000

出　　处：《中国煤炭工业医学杂志》2022年第6期668-672,共5页Chinese Journal of Coal Industry Medicine

基　　金：四川省医学科研课题计划项目(编号:No.Q181056)。

摘　　要：目的 分析甲状腺微小乳头状癌(PTMC)超声特征联合血清促甲状腺激素(TSH)检测对颈侧淋巴结转移的预测作用。方法 收集2018年3月—2021年3月该院收治的PTMC患者98例,根据术后病理有无淋巴结转移分为淋巴结转移例(转移组)39例,无淋巴结转移(无转移组)59例。比较有无淋巴结转移者超声特征、TSH表达水平,分析影响PTMC患者颈侧淋巴结转移的危险因素,计算超声联合TSH检测对颈侧淋巴结转移的预测价值以及其与病理诊断的一致性。结果 转移组在结节大小、结节个数、钙化情况上与无转移组比较差异有统计学意义(P<0.05),且转移组TSH表达水平则明显高于无转移组(P<0.05);二组在结节形态、内部回声、边缘、周围血流情况中比较差异并无统计学意义(P>0.05);结节≥1.5cm、多发结节、钙化、TSH>2.99(μIU/ml)为影响颈侧淋巴结转移的独立危险因素(P<0.05);超声+TSH诊断PTMC患者淋巴结转移敏感度、特异度、准确度分别为89.83%、92.30%、85.71%,明显高于超声、TSH单独检查(P<0.05),且与病理检查一致性高,kappa值为0.811(P<0.05)。结论 超声特征、TSH水平与PTMC患者淋巴结转移情况存在密切的联系,两者联合可为期淋巴结转移情况评估提供参考信息,对改善患者预后有积极意义。Objective To analyze the predictive effect of ultrasound characteristics of Papillary carcinoma of thyroid gland(PTMC)combined with serum thyroid stimulating hormone(TSH)detection on cervical lymph node metastasis.MethodsA total of ninety-eight patients with PTMC who were admitted to People's Hospital of Ganzi Tibetan Autonomous Prefecture from March 2018 to March 2021 were collected.According to the pathology,they were divided into 39 patients with lymph node metastasis(metastasis group)and 59 patients without lymph node metastasis(non-metastasis group).The ultrasound characteristics and TSH expression levels of patients with or without lymph node metastasis were compared,the risk factors affecting cervical lymph node metastasis in patients with PTMC were analyzed,and the predictive value of ultrasound combined with TSH detection for cervical lymph node metastasis and its consistency with pathological diagnosis were calculated.ResultsThe metastasis group was different from the non-metastasis group in terms of nodule size,number of nodules,and calcification(P<0.05),and the TSH expression level of the metastasis group was significantly higher than that of the non-metastasis group(P<0.05);There was no difference in nodule morphology,internal echo,margins,and peripheral blood flow(P>0.05);nodules≥1.5 cm,multiple nodules,calcification,TSH>2.99(μIU/ml)were independent risk factors affecting the cervical lymph nodes for metastasis(P<0.05);the sensitivity,specificity,and accuracy of ultrasound+TSH in diagnosing lymph node metastasis in patients with PTMC were 89.83%,92.30%,85.71%,which were significantly higher than those of ultrasound and TSH alone(P<0.05),and high consistency with pathological examination,kappa value was 0.811(P<0.05).Conclusion There is a close relationship between ultrasound characteristics,TSH level and lymph node metastasis in patients with PTMC.The combination of the two can provide reference information for the assessment of lymph node metastasis in the future,and has positive significance fo

关 键 词：甲状腺微小乳头状癌 超声特征 TSH 颈侧淋巴结转移 

分 类 号：R736.1[医药卫生—肿瘤]