被膜侵犯的甲状腺微小乳头状癌发生颈部淋巴结转移的超声相关危险因素分析  

Ultrasound-related risk factors for cervical lymph node metastasis of papillary thyroid microcarcinoma with extracapsular invasion

作　　者：李素娟[1] 丁文波[1] 武心萍[1] 邓学东[2] Li Sujuan;Ding Wenbo;Wu Xinping;Deng Xuedong(Department of Ultrasound,Jiangsu Province Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing 210028,China;Center of Medical Ultrasound,Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215002,China)

机构地区：[1]江苏省中西医结合医院超声科,南京210028 [2]南京医科大学附属苏州医院、苏州市立医院超声中心,215002

出　　处：《中华医学超声杂志（电子版）》2023年第4期455-461,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨被膜侵犯的甲状腺微小乳头状癌(PTMC)发生颈部淋巴结转移的超声相关危险因素。方法回顾性选取2015年1月至2021年12月在江苏省中西医结合医院行手术治疗、最终经手术病理证实的存在被膜侵犯的单灶性PTMC患者共计94例,依据术后组织病理学结果,将患者分为颈部淋巴结转移组48例和对照组(无颈部淋巴结转移组)46例。纳入结节均进行术前常规二维超声、超声弹性成像及超声造影检查,常规扫查颈部淋巴结。对淋巴结转移组与无淋巴结转移组的临床及超声特征进行单因素分析,将单因素分析有统计学意义的特征纳入多因素Logistic回归分析,得出被膜侵犯PTMC淋巴结转移的独立危险因素。结果对淋巴结转移组与无淋巴结转移组的性别、年龄、是否合并桥本甲状腺炎、结节最大直径、纵横比(A/T)、与被膜接触范围及微钙化、弹性评分进行单因素分析。单因素分析结果显示,淋巴结转移组与无淋巴结转移组是否存在微钙化差异有统计学意义(P<0.05),与被膜接触范围2组比较差异有统计学意义(P=0.001)。多因素Logistic回归分析结果显示,被膜接触范围>50%与微钙化灶均为单灶被膜侵犯PTMC淋巴结转移的独立危险因素(OR=8.401,95%CI:2.554~27.640,P<0.001;OR=8.039,95%CI:2.670~24.209,P<0.001)。结论多种模式联合应用的超声声像图在预测被膜侵犯的PTMC是否存在颈部淋巴结转移方面具有重要价值。微钙化、肿瘤与甲状腺被膜接触范围对PTMC患者是否存在颈部淋巴结转移具有一定预测价值。Objective To identify the risk factors for cervical lymph node metastasis of papillary thyroid microcarcinoma(PTMC)with extracapsular invasion.Methods A total of 94 patients with unifocal PTMC with extracapsular invasion who underwent surgical treatment at the Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine from January 2015 to December 2021 and were finally confirmed by surgical pathology were retrospectively selected and divided into either a cervical lymph node metastasis group(48 patients)or a no cervical lymph node metastasis group(control group;48 patients)based on postoperative histopathological findings.All included nodes underwent routine preoperative 2D ultrasound,ultrasound elastography,and ultrasonography,and the cervical lymph nodes were routinely scanned.The clinical and ultrasound characteristics of patients in the the two groups were analysed univariately,and the characteristics with statistical significance in the univariate analysis were included in multivariate logistic regression analysis to indentify independent risk factors for cervical lymph node metastasis of PTMC with extracapsular invasion.Results Univariate analysis was performed on gender,age,presence of combined Hashimoto's thyroiditis,maximum nodule diameter,aspect ratio(A/T),extent of contact with the capsule,microcalcifications,and elasticity score in the lymph node metastasis group versus the no lymph node metastasis group.The results of the univariate analysis showed that there was a statistically significant difference between the lymph node metastasis group and the no lymph node metastasis group for the presence of microcalcifications(P<0.05)and the extent of contact with the capsule(P=0.001).Multivariate logistic regression analysis showed that microcalcification foci,and the extent of contact with the capsule of>50%were independent risk factors for lymph node metastasis in unifocal PTMC with extracapsular invasion(odds ratio[OR]=8.401,95%confidence interval[CI]:2.554-27.640,P<0.001;OR=8.039,

关 键 词：甲状腺乳头状癌 超声检查 淋巴结转移 被膜侵犯 

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]