超声征象对甲状腺微小乳头状癌的预测价值

目的探讨多种超声征象对甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)的预测价值。方法回顾性分析2013年1月至2016年12月浙江省杭州市第一人民医院超声科经病理证实且直径≤1 cm的396例603枚微小结节性甲状腺肿(micronodular goiter,MNG)和539例640枚PTMC的超声资料,按照不同检查时间,将所有结节分为模型组(2013~2014年)和检验组(2015~2016年),观察瘤体形态、内部回声、微钙化及纵横比(A/T),采用单因素χ^2检验和多因素Logistic回归分析4种超声征象在PTMC和MNG中的分布差异,并评估其诊断价值。结果模型组和检验组的单因素分析显示,MNG及PTMC的瘤体形态(模型组:χ^2=283.54,P=0.000;检验组:χ^2=298.119,P=0.000)、内部回声(模型组:χ^2=63.130,P=0.000;检验组:χ^2=87.400,P=0.000)、微钙化(模型组:χ^2=26.342,P=0.000;检验组:χ^2=50.152,P=0.000)及A/T(模型组:χ^2=169.918,P=0.000;检验组:χ^2=181.405,P=0.000)等超声征象差异具有统计学意义。多因素Logistic回归分析显示形态不规则、低回声、A/T>1和微钙化是PTMC的影响因素,OR值分别为18.410和19.231、2.560和6.380、9.379和6.724、3.102和8.830,模型组和检验组多种超声征象预测概率曲线下面积值分别为0.916和0.911。结论形态不规则、内部低回声、微钙化和A/T>1均是预测PTMC稳定的重要超声征象,对多种超声征象进行综合分析可提高诊断效能。

The predictive value of various ultrasonic signs for papillary thyroid microcarinoma

Objective To explore the predictive value of various ultrasonic signs for papillary thyroid microcarcinoma(PTMC).Methods The ultrasonic data of of 603 micronodular goiter(MNG)in 396 cases and 640 PTMC in 539 cases,which were confirmed by pathology from Jan.2013 to Dec.2016,were retrospectively analyzed.According to the different inspection time,all nodules were divided into model group(2013-2014 years)and test group(2015-2016 years).The tumor morphology,internal echo,microcalcification,and aspect ratio(A/T)were observed.Chi-square test and multivariate Logistic regression analysis were used to analyze the distribution differences of the four ultrasound features in PTMC and MNG,and their diagnostic value was evaluated.Results There were statistical difference between model group and test group in ultrasonic signs including tumors shape,internal echo,microcalcification and aspect ratio according single factor analysis(chi square value was 283.540 and 298.119,63.130 and 87.400,26.342 and 50.152,169.918 and 181.405;P<0.05);Multivariable Logistic regression analysis showed that irregular shape,hypoecho,A/T>1 and microcalcification were more common in PTMC(P<0.05).OR values were 18.410 and 19.231,2.560 and 6.380,9.379 and 6.724,3.102 and 8.830,and AUC prediction probability values were 0.916 and 0.911 respectively.Conclusions Irregular shape,internal hypoechoic,microcalcification and A/T>1 are stable important ultrasonographic signs in predicting PTMC.Comprehensive analysis of various ultrasonic signs can improve the diagnostic efficiency.