超声联合血清TSH、FGF-19检测在甲状腺癌术前N分期中的应用价值  

Application value of ultrasound combined with serum TSH and FGF-19 in preoperative N staging of thyroid cancer

作　　者：富威东 程起[2] FU Weidong;CHENG Qi(Department of Ultrasound Medicine,Xiaoshan Hospital Affiliated to Hangzhou Normal University,Hangzhou 311202,China)

机构地区：[1]杭州师范大学附属萧山医院超声医学科,浙江杭州311202 [2]深圳市宝安区人民医院超声科

出　　处：《全科医学临床与教育》2024年第6期497-500,505,共5页Clinical Education of General Practice

摘　　要：目的探讨超声联合血清促甲状腺激素(TSH)、成纤维细胞生长因子19(FGF-19)检测在甲状腺癌术前N分期中的应用价值。方法回顾分析2021年10月至2022年10月在深圳市宝安区人民医院实施甲状腺切除手术的100例患者临床资料,根据术后淋巴结节活检病理结果将其分为pN0期、pN1a期和pN1b期,采用Kappa检验分析超声评估N分期和病理评估的一致性;采用单因素及多因素分析甲状腺癌术前N分期的影响因素,并绘制受试者工作特征(ROC)曲线分析超声联合血清TSH、FGF-19检测对甲状腺癌术前N分期诊断的价值。结果术前超声评估N分期与病理N分期呈中等一致性(Kappa=0.52,P<0.05)。单因素分析提示超声结节数量、纵横比、形态、边缘情况及血清TSH、FGF-19水平与术前N分期相关(χ^(2)分别=15.76、4.83、29.19、28.93,t分别=8.17、12.21,P均<0.05),多因素分析显示超声征象(结节数量、纵横比、形态、边缘情况)及血清TSH、FGF-19水平均为甲状腺癌术前N分期的独立影响因素(OR分别=1.04、1.30、1.05、1.29、1.18、1.62,P均<0.05)。ROC分析显示超声联合血清TSH、FGF-19检测诊断术前N分期的曲线下面积(AUC)为0.87,灵敏度为81.08%,特异度为93.65%,其中AUC、特异度均明显高于单一诊断(Z分别=5.64、8.24、4.52,χ^(2)分别=7.50、13.18、10.79,P均<0.05)。结论术前超声联合血清TSH、FGF-19对甲状腺癌术前N分期的诊断具有一定价值,三者联合可提高诊断特异度,为淋巴结转移的早期诊断提供可靠信息。Objective To investigate the application value of ultrasound combined with serum thyroid stimulating hormone(TSH)and fibroblast growth factor-19(FGF-19)in preoperative N staging of thyroid cancer.Methods The clinical data of 100 patients who underwent thyroidectomy in Shenzhen Bao'an People's Hospital from October 2021 to October 2022 were analyzed retrospectively.The lesions were divided into pN0 stage,pN1a stage and pN1b stage according to postoperative pathological results.Kappa test was conducted to analyze the consistency of N staging using ultrasound and pathological results.The risk factors of N staging of thyroid cancer were analyzed through univariate analysis and multivariate analysis.The value of ultrasound combined with serum TSH and FGF-19 in preoperative N staging of thyroid cancer was analyzed using the receiver operating characteristic(ROC)curve.Results There was moderate consistency between preoperative ultrasound evaluation of N staging and pathological N staging(Kappa=0.52,P<0.05).Univariate analysis found that the number,aspect ratio,morphology and edge of nodules,serum TSH and FGF-19 were correlated with preoperative N staging(χ^(2)=15.76,4.83,29.19,28.93,t=8.17,12.21,P<0.05).Multivariate analysis found that ultrasonic signs(number,aspect ratio,morphology and edge of nodules)and serum TSH and FGF-19 levels were independent influencing factors for preoperative N staging of thyroid cancer(OR=1.04,1.30,1.05,1.29,1.18,1.62,P<0.05).ROC analysis showed that the area under the curve(AUC)of ultrasound combined with serum TSH and FGF-19 for preoperative N staging was 0.87,with sensitivity of 81.08%and specificity of 93.65%.The AUC and specificity were significantly higher than those of single diagnosis(Z=5.64,8.24,4.52,χ^(2)=7.50,13.18,10.79,P<0.05).Conclusion Ultrasound combined with serum TSH and FGF-19 is helpful for preoperative N staging of thyroid cancer.The combination of the three can improve diagnostic specificity and provide reliable information for early diagnosis of lymph node metastasis

关 键 词：超声 促甲状腺激素 成纤维细胞生长因子-19 甲状腺癌 N分期 淋巴结转移 

分 类 号：R736.1[医药卫生—肿瘤]