TI-RADS分级与被膜侵犯对甲状腺乳头状癌淋巴结转移的诊断价值分析

目的探讨超声影像报告与数据系统（thyroid imaging reporting and date system，TI-RADS）与肿瘤侵犯被膜对甲状腺乳头状癌(papillary thyroid carcinoma，PTC)合并中央区淋巴结转移（central lymph node metastasis，CLNM)的诊断价值。 方法收集手术切除并经病理证实的单发PTC患者279例，记录患者的性别、年龄、PTC结节的回声、边界、纵横比、微钙化以及结节与甲状腺被膜的关系，根据超声特征给予每个结节TI-RADS分级，结合每例患者的颈部淋巴结病理结果，回顾分析TI-RADS分级与被膜受侵对PTC中央区淋巴结转移的诊断价值。 结果单因素分析显示：男性、TI-RADS分级为4c/5级、边界模糊、被膜受侵的甲状腺乳头状癌患者易发生CLNM（P＜0.05）；多因素分析显示：男性、边界模糊及甲状腺被膜受侵是CLNM的独立危险因素（OR=0.437、2.260、3.603，P＜0.05）。 结论男性、肿瘤边界模糊及其侵犯甲状腺被膜是CLNM的独立危险因素，TI-RADS分级越高淋巴结转移的可能性越大，TI-RADS分级为4c/5级对CLNM具有预测价值。

Diagnostic value of TI-RADS grades and tumor invasion into thyroid capsule in papillary thyroid carcinoma with cervical lymph node metastases

ObjectiveTo explore the diagnostic value of thyroid imaging reporting and data system(TI-RADS) and tumor invasion into thyroid capsule for papillary thyroid carcinoma(PTC) with central lymph node metastasis (CLNM).MethodsA total of 279 patients with single PTC that was surgically removed and pathologically confirmed in our hospital were enrolled in this study. The gender, age, echo of PTC nodules, boundary, aspect ratio, microcalcifications and the relationship between nodules and thyroid capsule were recorded. According to ultrasound characteristics, each nodule was graded based on the TI-RADS grading. Combined with the pathological results of cervical lymph node in each patient, we retrospectively analyzed the value of TI-RADS grading and tumor invasion into thyroid capsule in the diagnosis of PTC with CLNM.ResultsThe univariate analysis showed that male PTC patients with TI-RADS 4c/5, poorly-defined boundary, and the tumor invasion into thyroid capsule are more likely to experience CLNM(P＜0.05). The multivariate analysis showed that male gender, poorly-defined boundary and the tumor invasion into thyroid capsule were independent risk factors for CLNM（OR=0.437, 2.260, 3.603， all P＜0.05）.ConclusionMale gender, poorly-defined boundary and the tumor invasion into thyroid capsule were independent risk factors for CLNM. Meanwhile, the higher the TI-RADS grades, the greater the possibility of CLNM. Therefore, the TI-RADS 4c/5 has predictive values for CLNM.