多模态超声对甲状腺微小乳头状癌颈部淋巴结转移的预测价值

目的探讨术前常规超声、超声造影及超微血管成像（SMI）的多模态超声对甲状腺微小乳头状癌（PTMC）颈部淋巴结转移（CLNM）的预测价值。 方法回顾性分析首都医科大学附属北京天坛医院2018年10月至2021年4月经手术病理证实的99例PTMC患者，术前均行常规超声、超声造影和SMI检查。根据手术病理结果分为颈部淋巴结未转移组60例和转移组39例。观察并记录PTMC常规超声、超声造影、SMI及临床相关特征。应用单因素分析方法（独立样本t检验、χ²检验和Fisher确切概率法）比较2组患者多模态超声和临床特征的差异，将差异有统计学意义的因素纳入多因素Logistic回归分析，分析PTMC颈部淋巴结转移的危险因素。 结果单因素分析显示，与颈部淋巴结转移组比较，颈部淋巴结未转移组患者年龄大［（47.50±11.48）岁 vs（39.67±9.95）岁］，癌灶最大径小［（0.66±0.02）cm vs（0.77±0.02）cm］，单发癌灶最大径或多发癌灶最大径之和＞1.0 cm占比低（13/60 vs 17/39）、微钙化数量少（无、有且≤5个、＞5个：23、23、14 vs 10、10、19）、超声造影呈等或高增强比例低（9/60 vs 13/39）、增强早期病灶周围被膜连续性中断的比例较低（14/60 vs 17/39），差异具有统计学意义（t=3.491、P=0.001；t=3.376、P=0.001；χ²=5.379、P=0.020；χ²=6.854、P=0.032；χ²=4.596、P=0.032；χ²=4.509、P=0.034）。多因素分析显示患者年龄越小（OR=0.933，P=0.004）、癌灶最大径越大（OR=30.567，P=0.046），颈部淋巴结转移的风险越高；增强早期PTMC临近被膜连续性中断将增加PTMC颈部淋巴结转移的风险（OR=0.296，P=0.032）。 结论患者年龄较小、PTMC较大及增强早期癌灶周边被膜连续性中断是预测PTMC颈部淋巴结转移的独立危险因素，术前多模态超声检查特征对于PTMC患者是否发生CLNM有一定预测价值。

Predictive value of multimodal ultrasonography in cervical lymph node metastasis of thyroid micropapillary carcinoma

ObjectiveTo investigate the predictive value of multimodal ultrasound consisting of conventional ultrasound, contrast-enhanced ultrasound, and superb microvascular imaging (SMI) in cervical lymph node metastasis (CLNM) of papillary thyroid microcarcinoma (PTMC). MethodsA retrospective analysis was performed on 99 patients with pathologically confirmed PTMC at Beijing Tiantan Hospital, Capital Medical University from October 2018 to April 2021. Conventional ultrasound, contrast-enhanced ultrasound, and SMI were all performed preoperatively. According to pathologic results, the patients were divided into either a non-metastatic cervical lymph node group (n=60) or a metastatic cervical lymph node group (n=39). Features of multimodal ultrasound and clinical data of PTMC were observed and recorded. Independent-sample t test, Chi-square test, and Fisher exact test were used to compare the differences in all features between the two groups, and the statistically significant factors were included in multivariate Logistic regression analysis to identify the independent risk factors for PTMC with CLNM. ResultsUnivariate analysis showed that compared with the patients with CLNM, the patients without CLNM were older (47.50±11.48) years vs (39.67±9.95) years], had smaller PTMC (0.66±0.02) cm vs (0.77±0.02) cm], were less likely to have the maximum diameter of single carcinoma or the sum of the maximum diameter of multiple carcinoma＞1.0 cm (13/60 vs 17/39), had less microcalcifications (none, ≤5 but not none, and＞5∶23, 23, and 14 vs 10, 10, and 19, respectively), were less likely to have PTMC with equal or high density enhancement (9/60 vs 13/39), and were less likely to have interruption of capsule continuity in early stage of contrast-enhanced ultrasound (14/60 vs 17/39) (t=3.491, P=0.001; t=3.376, P=0.001; χ²=5.379, P=0.020; χ²=6.854, P=0.032; χ²=4.596, P=0.032; and χ²=4.509, P=0.034, respectively). Multivariate analysis showed that younger age (odds ratio OR]=0.933, P =0.004), larger PTMC (OR=30.567,P=0.046), and interruption of capsule continuity in early stage of contrast-enhanced ultrasound (OR=0.296, P=0.032) independently increased the risk of CLNM in PTMC. ConclusionYounger age, larger PTMC, and interruption of capsule continuity in early stage of contrast-enhanced ultrasound are independent risk factors for predicting CLNM of PTMC. The features of preoperative multimodal ultrasound have appreciated predictive value for CLNM in patients with PTMC.