CT纹理分析联合基线资料对cN0甲状腺微小乳头状癌淋巴结转移的预测  

Prediction of lymph node metastasis in cN0 papillary thyroid microcarcinoma by CT texture analysis combined with baseline data

作　　者：钱欢欢 秦连进[2] 邓冬平 Qian Huanhuan;Qin Lianjin;Deng Dongping(Department of Radiology,the First People’s Hospital of Huzhou,Huzhou 313000,China;Department of Herniorrhaphy,the First People’s Hospital of Huzhou City,Huzhou 313000,China)

机构地区：[1]湖州市第一人民医院放射科,湖州313000 [2]湖州市第一人民医院甲乳腹壁疝外科,湖州313000

出　　处：《中华内分泌外科杂志》2023年第5期603-607,共5页Chinese Journal of Endocrine Surgery

基　　金：湖州市科学技术项目(2021GY814)。

摘　　要：目的探讨分析CT纹理联合基线资料对cN0甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)淋巴结转移(lymph node metastasis,LNM)预测价值,旨在为PTMC的LNM评估提供依据。方法选取湖州市第一人民医院放射科和甲乳腹壁疝外科2020年8月至2022年8月经手术病理证实的106例单发性cN0期PTMC患者进行回顾性分析,根据术中LNM情况将患者分为LNM组22例,无LNM组84例,均进行CT检查,在CT影像中勾画出转移淋巴结及非转移性淋巴结,并获取淋巴结CT纹理特征图像。分析LNM和非LNM CT纹理特征差异,采用Logistic回归分析CT纹理与LNM的关系,并绘制ROC曲线评估CT纹理对cN0期PTMC患者LNM的预测价值。根据CT征象中瘤体与甲状腺边缘接触范围的不同情况将患者分为<1/4组51例、1/4~<1/2组36例、≥1/2组19例,分析各组基线资料及LNM分布情况。结果单因素分析结果显示,LNM组和无LNM组CT纹理特征中肿瘤位置、瘤体钙化和甲状腺球蛋白差异无统计学意义(P>0.05);而LNM组瘤体与甲状腺边缘接触情况、瘤体直径≥7 mm、年龄<45、性别男性占比高于无LNM组(P<0.05)。多因素Logistic回归分析结果显示,瘤体与甲状腺边缘接触(OR=6.080,95%CI:1.738~21.273)、瘤体直径≥7 mm(OR=2.779,95%CI:1.135~6.805)、年龄<45岁(OR=6.074,95%CI:1.980~18.636)、性别男性(OR=12.642,95%CI:3.125~51.136)是cN0期PTMC患者LNM的独立危险因素(P<0.05)。<1/4组、1/4~1/2组、≥1/2组3组性别、年龄、瘤体直径、肿瘤位置、瘤体钙化、甲状腺球蛋白等资料差异无统计学意义(P>0.05)。≥1/2组LNM发生率高于<1/4组和1/4~1/2组且组间两两比较差异有统计学意义(P<0.05)。结论瘤体与甲状腺边缘接触、瘤体直径≥7 mm、年龄<45岁、性别男性是cN0期PTMC患者LNM的独立危险因素,且瘤体与甲状腺边缘接触范围越广,LNM风险越高,CT纹理分析联合基线资料预测cN0 PTMC LNM具有重要参考价值。Objective To explore and analyze the value of CT texture combined with baseline data in lymph node metastasis of cN0 papillary thyroid microcarcinoma(PTMC),in order to provide evidence for the evaluation of lymph node metastasis of PTMC.Methods 106 patients with single stage cN0 papillary PTMC confirmed by operation and pathology in Department of Radiology and Hernia Department of Huzhou First People’s Hospital from Aug.2020 to Aug.2022 were selected for retrospective analysis.Metastatic lymph nodes and non-metastatic lymph nodes were delineated in CT images,and they were divided into a lymph node metastasis group(22 cases)and a group without lymph node metastasis(84 cases).At the same time,lymph node CT texture feature images were obtained in both groups.Logistic regression was used to analyze the relationship between CT texture and lymph node metastasis,and ROC curve was drawn to evaluate the predictive value of CT texture for lymph node metastasis in cN0 stage PTMC patients.The patients were divided into<1/4 group(51 cases),1/4-<1/2 group(36 cases),and≥1/2 group(19 cases)according to the different contact range between tumor and thyroid margin in CT signs.The baseline data and lymph metastasis distribution of each group were analyzed.Results The results of single factor analysis showed that there were no differences in tumor location,tumor calcification or thyroglobulin in CT texture between LNM group and non-LNM group(P>0.05).The incidence of tumor contact with thyroid margin,tumor diameter≥7 mm,age<45 and male ratio of sex in LNM group were higher than those in non-LNM group(P<0.05).Multivariate Logistic regression analysis showed that tumor was in contact with thyroid margin(OR=6.080,95%CI:1.738-21.273),tumor diameter≥7 mm(OR=2.779,95%CI:1.135-6.805),age<45 years old(OR=6.074,95%CI:1.980-18.636)and gender male(OR=12.642,95%CI:3.125-51.136)were independent risk factors for lymph node metastasis in cN0 stage PTMC patients(P<0.05).There were no significant differences in gender,age,tumor diameter,tumor

关 键 词：甲状腺微小乳头状癌 CT纹理特征 淋巴结转移 

分 类 号：R736.1[医药卫生—肿瘤]