灰阶超声联合SWE预测甲状腺微小乳头状癌中央区淋巴结转移

目的 探讨甲状腺微小乳头状癌（PTMC）二维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相关性。方法 收集接受甲状腺手术且行中央区淋巴结清扫的PTMC患者，术前均接受二维超声及SWE检查，依有无中央区淋巴结转移将其分为转移组（46例）与未转移组（70例），分析PTMC二维超声特征及SWE定量参数与中央区淋巴结转移的相关性。结果 PTMC患者Emax、Emean在两组间比较差异有统计学意义（P均＜0.05），ROC曲线分析，Emax、Emean曲线下面积分别为0.851、0.752，分别以Emax43.35kPa和Emean30.15kPa作为诊断界值，其诊断敏感性、特异性为87%、72.9%和78.3%、61.4%。单因素析显示，多发、边缘不光整、形态不规则、微钙化、侵犯被膜、Emax是PTMC中央区淋巴结转移的危险因素（P均＜0.05）。多因素Logistic回归分析进一步显示，多发、侵犯被膜、Emax值是PTMC中央区淋巴结转移的独立危险因素（P均＜0.05）。结论 SWE可预测PTMC中央区淋巴结转移，同时具有多灶、侵犯被膜及Emax＞43.43kPa时PTMC中央区淋巴结转移风险明显增高，建议临床预防性行中央区淋巴结清扫。

Gray-scale ultrasound combined with SWE predicts CLNM of PTMC

Objective To investigate the correlation between the two-dimensional ultrasound features and quantitative parameters of SWE of papillary thyroid microcarcinoma(PTMC) and central lymph node metastasis(CLNM).Methods Patients with PTMC who underwent thyroidectomy and central lymph node dissection underwent two-dimensional ultrasonography and SWE before surgery. They were divided into metastatic group (46 cases) and non-transfer group(70 cases) according to CLNM, the correlation between PTMC two-dimensional ultrasound features and SWE quantitative parameters and CLNM was analyzed. Results The differences between Emax and Emean in PTMC patients were statistically significant (P<0.05).The ROC curve analysis showed that the areas under Emax and Emean curves were 0.851 and 0.752. Emax43.35kPa and Emean30.15kPa were used as diagnostic thresholds respectively, and their diagnostic sensitivity and specificity were 87%, 72.9%, and 78.3%, 61.4%.The results of single factor analysis showed that multiple, marginal irregularities, irregular morphology, microcalcification, invasion of the capsule, and Emax were risk factors for CLNM of PTMC (P<0.05). Multivariate logistic regression analysis further showed that multiple, invasive capsules and Emax values were independent risk factors for CLNM of PTMC (P<0.05).Conclusion SWE can predict the CLNM of PTMC, and when there were multiple foci, invasion of the capsule and Emax>43.43 kPa, the risk of CLNM of PTMC was significantly increased,preventive central lymph node dissection is recommended .