分化型甲状腺癌患者伴初始淋巴结转移的术后颈部超声检查及危险分层。

Post-operative neck ultrasound and risk stratification in differentiated thyroid cancer patients with initial lymph node involvement.

机构信息

Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France.

Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France

出版信息

Eur J Endocrinol. 2014 Jun;170(6):837-46. doi: 10.1530/EJE-13-0888. Epub 2014 Mar 21.

DOI:10.1530/EJE-13-0888

PMID:24659355

Abstract

OBJECTIVE

Cervical ultrasound (US) scan is a key tool for detecting metastatic lymph nodes (N1) in patients with papillary thyroid cancer (PTC). N1-PTC patients are stratified as intermediate-risk and high-risk (HR) patients, according to the American Thyroid Association (ATA) and European Thyroid Association (ETA) respectively. The aim of this study was to assess the value of post-operative cervical US (POCUS) in local persistent disease (PD) diagnosis and in the reassessment of risk stratification in N1-PTC patients.

DESIGN

Retrospective cohort study.

METHODS

Between 1997 and 2010, 638 N1-PTC consecutive patients underwent a systematic POCUS. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of POCUS for the detection of PD were evaluated and a risk reassessment using cumulative incidence functions was carried out.

RESULTS

After a median follow-up of 41.6 months, local recurrence occurred in 138 patients (21.6%), of which 121 were considered to have PD. Sensitivity, specificity, NPV, and PPV of POCUS for the detection of the 121 PD were 82.6, 87.4 95.6, and 60.6% respectively. Cumulative incidence of recurrence at 5 years was estimated at 26% in ETA HR patients, 17% in ATA intermediate-risk patients, and 35% in ATA HR patients respectively. This risk fell to 9, 8, and 11% in the above three groups when the POCUS result was normal and to <6% when it was combined with thyroglobulin results at ablation.

CONCLUSION

POCUS is useful for detecting PD in N1-PTC patients and for stratifying individual recurrence risk. Its high NPV could allow clinicians to tailor follow-up recommendations to individual needs.

摘要

目的

颈部超声（US）扫描是检测甲状腺乳头状癌（PTC）患者转移性淋巴结（N1）的关键工具。根据美国甲状腺协会（ATA）和欧洲甲状腺协会（ETA）的标准，N1-PTC 患者分别被分为中危和高危（HR）患者。本研究旨在评估术后颈部超声（POCUS）在局部持续性疾病（PD）诊断中的价值，以及在 N1-PTC 患者风险分层中的再评估价值。

设计

回顾性队列研究。

方法

1997 年至 2010 年间，638 例连续的 N1-PTC 患者接受了系统的 POCUS。评估了 POCUS 检测 PD 的敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV），并使用累积发生率函数进行了风险再评估。

结果

中位随访 41.6 个月后，138 例（21.6%）患者出现局部复发，其中 121 例被认为存在 PD。POCUS 检测 121 例 PD 的敏感性、特异性、NPV 和 PPV 分别为 82.6%、87.4%、95.6%和 60.6%。ETA HR 患者、ATA 中危患者和 ATA HR 患者 5 年复发累积发生率分别估计为 26%、17%和 35%。当 POCUS 结果正常时，上述三组患者的复发风险分别降至 9%、8%和 11%，当 POCUS 结果与消融时的甲状腺球蛋白结果相结合时，风险降至<6%。