术前甲状腺癌超声检查特征与颈部淋巴结转移的多因素分析

摘要

目的：探讨术前甲状腺癌的超声检查特征与颈部淋巴结转移的关系。方法回顾性分析2006年至2015年病理诊断为甲状腺癌患者196例，共246个甲状腺癌结节的术前超声表现进行分析。记录甲状腺癌结节的超声特征，进行甲状腺癌超声表现与颈部淋巴结转移的多因素分析，并绘制ROC曲线评价甲状腺癌结节的超声特征预测颈部淋巴结转移的诊断效能。结果术前超声诊断甲状腺癌颈部淋巴结转移的灵敏度为81-．40％（105／129），特异度为92．32％（108／117），阳性预测值为92．11％（105／114），阴性预测值为81．82％（108／132）。甲状腺癌患者颈部转移性淋巴结最常见Ⅵ区，其次为Ⅳ区和Ⅲ区。多因素分析的结果显示甲状腺癌结节大小、边界与被膜接触面积、微钙化和血流分级是甲状腺患者发生颈部淋巴结转移的危险因素（ P ＜0．05），癌结节大小、甲状腺被膜侵犯、微钙化和血流分级诊断颈部淋巴结转移的效能较好，ROC曲线下面积分别为0．807、0．856、0．881和0．812。结论甲状腺癌患者的癌结节最大直径、甲状腺被膜侵犯、微钙化和血流分级可能是预测颈部淋巴结转移的重要指标，综合多个指标判断可提高超声对甲状腺癌颈部转移性淋巴结的检出率，更好地为临床治疗提供参考。%Objective To investigate the ultrasonographic characteristics of thyroid carcinoma ( TC) , and to explore the correlation between the ultrasonographic characteristics and cervical lymph node metastasis ( LNM ) .Methods The preoperative ultrasonic manifestations about 196 patients with TC ( 246 thyroid carcinoma nodus ) who were diagnosed by pathology from 2006 to 2015 were retrospectively analyzed ,and the correlation between these characteristics and cervical LNM was evauated by multivariate analyses ,moreover , the ROC curve was drawn to evaluate the diagnostic significance by means of ultrasonographic characteristics of thyroid carcinoma nodus to predict cervical LNM .Results The sensitivity, specificity, positive predictive value, negative predictive value of preoperative ultrasonographic diagnosis was 81.40% (105/129), 92.32%(108/117), 92.11% (105/114),81.82% (108/132), respectively.The cervical LNM in TC was frequently occurred in cervical level VI (37.98%),next level Ⅳand level Ⅲ.Multivariate analysis showed that nodular size , contact area of capsular invasion , microcalcification and blood flow grade were risk factors for cervical LNM in patients with TC ( P <0.05).Furthermore,ROC curve analysis demonstrated important significance of nodular size ,capsular invasion,microcalcification and blood flow grade in predicting cervical LNM ,with the area under ROC curve being 0.807, 0.856, 0.881, 0.812, respectively .Conclusion The maximum diameter of thyroid carcinoma nodus , fibrous capsule invasion of thyroid gland , microcalcification and blood flow grade may be important indexes in predicting cervical LNM in patients with TC , moreover, the comprehensive evaluation of multi indexes can enhance detection rate of cervical LNM in TC and can provide valuable reference for clinical therapy .