甲状腺微小乳头状癌常规超声特征及剪切波弹性成像定量参数与中央区淋巴结转移的关系

目的探讨甲状腺微小乳头状癌(PTMC)常规超声特征及剪切波弹性成像(SWE)定量参数与中央区淋巴结转移的关系。方法收集我院接受甲状腺手术且行中央区淋巴结清扫的102例PTMC患者,共116个结节,术前均接受常规超声及SWE检查。根据有无中央区淋巴结转移将其分为转移组(36例)和未转移组(66例),比较两组SWE定量参数即杨氏模量最大值(Emax)、最小值(Emin)及平均值(Emean);受试者工作特征(ROC)曲线分析SWE定量参数判断PTMC有无中央区淋巴结转移的价值;多因素Logistic回归分析PTMC常规超声特征及SWE定量参数与中央区淋巴结转移的相关性。结果转移组与未转移组Emax、Emean比较差异均有统计学意义(均P<0.05);ROC曲线分析显示,以Emax 43.35 kPa和Emean 30.15 kPa为截断值,诊断PTMC中央区淋巴结转移的敏感性、特异性为87.0%、72.9%和78.3%、61.4%,曲线下面积分别为0.851、0.752。单因素分析显示,多发灶、边缘不光整、形态不规则、微钙化、侵犯被膜,以及Emax>43.43 kPa为PTMC中央区淋巴结转移的危险因素(均P<0.05);多因素Logistic回归分析进一步显示,多发灶、侵犯被膜、Emax>43.43 kPa是PTMC中央区淋巴结转移的独立危险因素(OR=0.259、6.662、16.684,均P<0.05)。结论SWE可预测PTMC中央区淋巴结转移;多发灶、侵犯被膜及Emax>43.43 kPa时发生PTMC中央区淋巴结转移的风险明显增高。

Relationship between conventional ultrasonic characteristics and shear wave elastography quantitative parameters of papillary thyroid microcarcinoma and central lymph node metastasis

Objective To investigate the relationship between the conventional ultrasonic features and quantitativeparameters of shear wave elastography(SWE)of papillary thyroid microcarcinoma(PTMC)and central lymph node metastasis.MethodsA total of 116 nodules were collected from 102 patients with PTMC who underwent thyroidectomy and central lymphnode dissection,they were divided into metastasis group(36 cases)and non-metastasis group(66 cases)according to the centrallymph node metastasis of postsurgery pathology.The quantitative parameters of SWE(Emax,Emin,Emean)were comparedbetween the two groups.The receiver operating characteristic(ROC)curve was used to analyze the value of SWE quantitativeparameters in PTMC for central lymph node metastasis.The correlation between ultrasonic features and SWE quantitativeparameters of PTMC and central lymph node metastasis were analyzed by Logistic regression analysis.ResultsThe differencesbetween Emax and Emean between two groups were statistically significant(both P<0.05).ROC curve analysis showed takingEmax 43.35 k Pa and Emean 30.15 k Pa as critical values,the sensitivity and specificity for diagnosing central region lymph nodemetastasis in PTMC were 87.0%,72.9%and 78.3%,61.4%,and the area under the curve were 0.851 and 0.752,respectively.Univariate analysis showed that multiple lesions,irregular margin and shape,microcalcification,invasion of tunica media andEmax>43.43 k Pa were risk factors for lymph node metastasis in PTMC central region(all P<0.05).Multivariate Logisticregression analysis showed that multiple cesions,invasion of tunica media and Emax>43.43 k Pa were independent risk factors forcentral lymph nodes metastasis of PTMC(OR=0.259,6.662,16.684,all P<0.05).ConclusionSWE can predict the centrallymph nodes metastasis of PTMC.The risk of PTMC central lymph node metastasis is significantly increased when multiplecesions,invasion of tunica media and Emax>43.43 k Pa.