可疑甲状腺乳头状癌颈侧区淋巴结转移相关影响因素:基于80例术前超声检查

  目的  探讨术前超声可疑甲状腺乳头状癌颈侧区淋巴结转移(LLNM)的相关影响因素。  方法  选取2010年1月~2021年1月于我院行门诊甲状腺常规超声检查高度怀疑甲状腺乳头状癌(PTC)患者80例，通过术前超声检查并接受手术治疗，术后经病理证实为PTC。通过术后病理分为颈侧区淋巴结转移组(LLNM组，n=46)、未发生颈侧区淋巴结转移组(NLLNM组，n=34)，收集其临床特征与超声声像图特征，采用多因素Logistic分析术前超声可疑LLNM相关的独立因素，ROC曲线计算分析患者肿瘤直径预测LLNM的最佳临界值。  结果  单因素分析显示两组患者的性别、被膜侵犯、淋巴门、中央区淋巴结转移、肿瘤直径、微钙化及结节纵横比差异均有统计学意义(P < 0.05)。多因素分析显示男性、发生被膜侵犯、中央区淋巴结转移、肿瘤直径、结节微钙化均是与LLNM相关的独立危险因素。ROC曲线表明患者肿瘤直径曲线截断点为1.404 cm，对LLNM诊断的敏感度为52.2%、特异性为88.2%，曲线下面积为0.709。  结论  男性、发生被膜侵犯、中央区淋巴结转移、肿瘤直径≥1.404 cm、结节微钙化对甲状腺乳头状癌颈侧区淋巴结转移具有重要预测价值，关注上述危险因素，可增加颈侧区淋巴结的检出率。 

Factors influencing preoperative ultrasound suspicion of lymph node metastasis in the lateral cervical region of papillary thyroid cancer

  Objective  To investigate the factors associated with preoperative ultrasound suspicion of lymph node metastasis (LLNM) in the lateral cervical region of papillary thyroid cancer.  Methods  From January 2010 to January 2021, our hospital line gland regular ultrasound examination of 80 patients with high suspicion of PTC were selected and treated with preoperative ultrasound and confirmed to have PTC by postoperative pathology. 80 patients were divided into a group with lymph node metastasis in the lateral cervical region (LLNM group, n=46) and a group without lymph node metastasis in the lateral cervical region (NLLNM group, n=34). NLLNM group, n=34), their clinical features and ultrasound sonographic features were collected, Independent factors related to preoperative ultrasound suspicion of LLNM were analyzed by multifactor Logistic analysis. The best critical value of LLNM was calculated from ROC curve by patient tumor diameter prediction.  Results  Univariate analysis showed statistically significant differences (P < 0.05) in gender, film violation, lymph node transfer, tumor diameter, and tumor diameter, nodule microcalification in the central area, and nodules of nodules were independent risk factors associated with LLNM. The ROC curve showed a tumour diameter cut-off point of 1.404 cm, with a sensitivity of 52.2% and specificity of 88.2%, and an area under the curve of 0.709.  Conclusion  Male, film violation, lymph node transfer, tumor diameter ≥1.404 cm, nodule microcetocrification on the lymph node metastasis of thyroid pillar carcinoma neck side zone has important predictive value, and attention to the above risk factors may increase the detection rate of the lymph nodes of the lateral cervical region.