曹皎皎,陈小敏,贾红靖,马丽媛,陆冰,马蕾.联合应用临床、超声和病理特征判断甲状腺乳头状癌Delphian淋巴结转移[J].中国介入影像与治疗学,2023,20(11):675-679
联合应用临床、超声和病理特征判断甲状腺乳头状癌Delphian淋巴结转移
Combination of clinical, ultrasonic and pathological features for diagnosing Delphian lymph node metastasis of papillary thyroid carcinoma
投稿时间:2023-05-20  修订日期:2023-08-25
DOI:10.13929/j.issn.1672-8475.2023.11.008
中文关键词:  甲状腺癌,乳头状  淋巴结转移  超声检查  病理学
英文关键词:thyroid cancer, papillary  lymphatic metastasis  ultrasonography  pathology
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作者单位E-mail
曹皎皎 南京医科大学附属苏州医院(苏州市立医院)超声科, 江苏苏州 215002  
陈小敏 苏州大学附属独墅湖医院超声科, 江苏 苏州 215124 13814853829@163.com 
贾红靖 南京医科大学附属苏州医院(苏州市立医院)超声科, 江苏苏州 215002  
马丽媛 南京医科大学附属苏州医院(苏州市立医院)超声科, 江苏苏州 215002  
陆冰 南京医科大学附属苏州医院(苏州市立医院)超声科, 江苏苏州 215002  
马蕾 南京医科大学附属苏州医院(苏州市立医院)超声科, 江苏苏州 215002  
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中文摘要:
      目的 观察联合应用甲状腺乳头状癌(PTC)临床、超声及病理特征判断其Delphian淋巴结转移(DLNM)的价值。方法 纳入358例接受甲状腺根治性切除术的PTC患者,根据术后病理显示DLNM状态分为阳性组(n=92)和阴性组(n=266);以单因素及多因素分析比较2组术前临床、超声和术后病理特征并建立模型,观察各模型诊断DLNM的价值。结果 基于临床+超声特征,男性、年龄≥45岁、双侧甲状腺受累,肿瘤超声形态不规则、甲状腺外侵犯(ETE)和颈部中央淋巴结转移(CLNM)是PTC DLNM的危险因素;PTC位于下极和峡部、伴结节性甲状腺肿为其保护因素。基于临床+病理特征,男性、年龄≥45岁、双侧甲状腺受累,病理学ETE(P-ETE)及CLNM是PTC DLNM的危险因素;PTC位于甲状腺下极和峡部、伴结节性甲状腺肿为其保护因素。基于临床+超声+病理特征,男性、年龄≥45岁、双侧甲状腺受累,超声显示肿瘤不规则形态、ETE和病理显示CLNM均为PTC DLNM的危险因素,而PTC位于下极和峡部、伴结节性甲状腺肿为保护因素。基于上述结果分别建立临床+超声、临床+病理和临床+超声+病理模型,其诊断PTC DLNM的曲线下面积(AUC)分别为0.823、0.732和0.856,以临床+超声+病理模型的AUC最高,且与临床+病理模型AUC差异有统计学意义(P<0.01)。结论 联合应用PTC临床、超声及病理特征有助于判断其DLNM。
英文摘要:
      Objective To observe the value of combination of clinical, ultrasonic and pathological features for diagnosing Delphian lymph node metastasis (DLNM) of papillary thyroid carcinoma (PTC). Methods A total of 358 PTC patients who underwent radical thyroidectomy were enrolled and divided into positive group (n=92) and negative group (n=266) according to pathological findings of DLNM. Preoperative clinical, ultrasonic and postoperative pathological features were compared between groups using univariate and multivariate analysis. Then relative models were established, and the value of each model for diagnosing DLNM was analyzed. Results Based on clinical+ultrasonic features, male, age≥45 years old, bilateral involvement, PTC with irregular ultrasonic morphology, ultrasonic extrathyroidal extension (ETE) and ultrasound cervical central lymph node metastasis (CLNM) were risk factors, while lower pole or isthmus PTC and complicated with nodular goiter were protective factors of PTC DLNM. Based on clinical+pathological features, male, age≥45 years old, bilateral involvement, pathology ETE (P-ETE) and pathological CLNM were risk factors, while lower pole or isthmus PTC and complicated with nodular goiter were protective factors of PTC DLNM. Based on clinical+ultrasonic+pathological features, male, age≥45 years old, bilateral involvement, irregular ultrasonic morphology PTC, ultrasonic ETE and pathological CLNM were risk factors, while lower pole oristhmus PTC and compicated with nodular goiter were protective factors of PTC DLNM. Finally clinical+ultrasonic, clinical+pathological and clinical+ultrasonic+pathological model were established, and the area under the curve (AUC) for diagnosing PTC DLNM was 0.823, 0.732 and 0.856, respectively. The AUC of clinical+ultrasonic+pathological model was the highest, which was of significant difference with that of clinical+pathological model (P<0.01). Conclusion Combination of clinical, ultrasonic and pathological features were helpful for diagnosing PTC DLNM.
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