Xu Jun-Mei, Xu Hui-Xiong, Li Xiao-Long, Bo Xiao-Wan, Xu Xiao-Hong, Zhang Yi-Feng, Guo Le-Hang, Liu Lin-Na, Qu Shen
From the Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute (J-MX, H-XX, X-LL, X-WB, Y-FZ, L-HG, L-NL) and Thyroid Institute (J-MX, H-XX, X-LL, X-WB, Y-FZ, L-HG, L-NL, SQ), and Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital (SQ), Tongji University School of Medicine, Shanghai, China; and Department of Ultrasound, Guangdong Medical College Affiliated Hospital, Zhanjiang, China (H-XX, X-HX).
Medicine (Baltimore). 2016 Jan;95(3):e2558. doi: 10.1097/MD.0000000000002558.
The aim of this prospective study was to propose a new rating system using a risk model including conventional ultrasound (US) and acoustic radiation force impulse (ARFI) elastography for predicting central lymph node metastasis (LNM) in patients with papillary thyroid microcarcinoma (PTMC).A total of 252 patients with PTMCs were enrolled, who were preoperatively evaluated by US and ARFI elastography including virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ). Risk factors of independent variables for central LNM were analyzed by univariate and multivariate analyses. A multivariate analysis was performed to create a predicting model and rating system.Of the 252 patients, 72 (28.6%) had central LNMs. Multivariate analysis revealed that rare internal flow (odds ratio [OR]: 4.454), multiple suspicious foci on US (OR: 5.136), capsule involvement (OR: 20.632), and VTI area ratio (VAR) > 1 (OR: 5.621) were independent risk factors for central LNM. The final predicting model was obtained and the risk score (RS) was defined as 1.5 × (if rare internal flow) + 1.6 × (if multiple suspicious foci on US) + 1.7 × (if VAR > 1) + 3.0 × (if capsule involvement). The rating system was divided into 5 stages. Stage I, <1.5; Stage II, 1.5 to 3.0; Stage III, 3.1 to 4.7; Stage IV, 4.8 to 6.3; and Stage V, 6.4 to 7.8. The risk rates of central LNM were 3.4% (2/59) in Stage I, 13.3% (13/98) in Stage II, 54.2% (39/72) in Stage III, 72.2% (13/18) in Stage IV, and 100% (5/5) in Stage V (P < 0.001).The results indicated that rare internal flow, multiple suspicious foci, capsule involvement on US, and VAR > 1 on ARFI elastography are the risk factors for predicting central LNM. The risk model developed in the study clearly predicts the risk of central LNM in patients with PTMC and thus has a potential to avoid unnecessary central compartment node dissection.
本前瞻性研究的目的是提出一种新的评分系统，该系统使用包含传统超声（US）和声学辐射力脉冲（ARFI）弹性成像的风险模型，以预测甲状腺微小乳头状癌（PTMC）患者的中央淋巴结转移（LNM）。共纳入252例PTMC患者，术前通过US和ARFI弹性成像进行评估，包括虚拟触诊组织成像（VTI）和虚拟触诊组织定量（VTQ）。通过单因素和多因素分析来分析中央LNM独立变量的危险因素。进行多因素分析以创建预测模型和评分系统。在这252例患者中，72例（28.6%）发生中央LNM。多因素分析显示，少见内部血流（比值比[OR]：4.454）、US上多个可疑病灶（OR：5.136）、包膜侵犯（OR：20.632）以及VTI面积比（VAR）>1（OR：5.621）是中央LNM的独立危险因素。获得了最终的预测模型，并将风险评分（RS）定义为1.5×（如果存在少见内部血流）+1.6×（如果US上有多个可疑病灶）+1.7×（如果VAR>1）+3.0×（如果存在包膜侵犯）。评分系统分为5个阶段。I期，<1.5；II期，1.5至3.0；III期，3.1至4.7；IV期，4.8至6.3；V期，6.4至7.8。中央LNM的风险率在I期为3.4%（2/59），II期为13.3%（13/98），III期为54.2%（39/72），IV期为72.2%（13/18），V期为100%（5/5）（P<0.001）。结果表明，少见内部血流、多个可疑病灶、US上的包膜侵犯以及ARFI弹性成像上的VAR>1是预测中央LNM的危险因素。本研究中开发的风险模型能够明确预测PTMC患者中央LNM的风险，因此有可能避免不必要的中央区淋巴结清扫。
