甲状腺乳头状癌常规超声图像特征及声触诊组织成像预测颈部淋巴结转移的价值研究

目的 :探讨甲状腺乳头状癌(Papillary thyroid carcinoma,PTC)原发灶的常规超声特征及声触诊组织成像(Virtual touch tissue imaging,VTI)对颈部淋巴结转移的预测价值。方法 :根据术后病理结果将77例PTC分为淋巴结转移组和非转移组,对其术前常规超声图像及VTI分级进行分析,比较各个因素与淋巴结的转移情况有无相关性。将各独立危险因素赋值为1,计算每个结节包含危险因素的分值,绘制ROC曲线,确定最佳截点。结果:单因素及多因素分析显示,微钙化、极低回声、血流Adler分级Ⅱ~Ⅲ级及VTI 6级为颈部淋巴结转移的独立危险因素。ROC曲线表明,PTC原发灶具备≥2项独立危险因素,对颈部淋巴结转移有较好的预测价值,其敏感度为94.7%,特异度为82.1%,准确性为88.3%。结论:PTC原发灶常规超声图像特征及VTI可以预测颈部淋巴结转移情况,微钙化、极低回声、血流Adler分级Ⅱ~Ⅲ级及VTI 6级是其独立危险因素。

The value of conventional ultrasound image features and virtual touch tissue imaging in the estimate of cervical lymph node metastasis of papillary thyroid carcinoma

Objective: To investigate the value of conventional ultrasound image features and virtual touch tissue imaging(VTI) in the estimate of cervical lymph node metastasis of papillary thyroid carcinoma(PTC). Methods: According to the postoperative pathological results, 77 patients with PTC were divided into lymph node metastasis group and non-metastasis group.The preoperative routine ultrasound images and VTI grades were analyzed to compare the correlation between each factor and lymph node metastasis. Assign each independent risk factor to 1, calculate the score for each nodule, receiver operating characteristic(ROC) curve was used to determine the cut off spot. Results: Monofactor and multivariate analysis showed the microcalcification, very hypoechoic, flow grade of Ⅱ~Ⅲ and VTI grade 6 were independent risk factors with cervical lymph node metastasis(P<0.05). The ROC curve showed that when PTC primary tumors had ≥2 independent risk factors, it had a high predictive value for cervical lymph node metastasis, the sensitivity, specificity, accuracy of predicting cervical lymph nodes metastasis was 94.7%, 82.1%, 88.3% respectively. Conclusion: Conventional ultrasound image features and VTI can predict cervical lymph node metastasis. Micro-calcification, very hypoechoic, flow grade of Ⅱ~Ⅲ and VTI grade 6 were independent risk factors for cervical lymph node metastasis.