Zhao Cheng, Jiang Wenbin, Gao Yuxiu, Niu Weidong, Zhang Xiaojuan, Xin Lei
Affiliated Hospital of Qingdao University, Qingdao, China.
J Int Med Res. 2017 Jun;45(3):1221-1230. doi: 10.1177/0300060517708943. Epub 2017 May 23.
Objective This study aimed to investigate the risk factors and clinical value of lymph node metastasis (LNM) and missed central lymph node metastasis (CLNM) using preoperative ultrasound (US) in patients with papillary thyroid microcarcinoma (PTMC). Methods This retrospective study included 521 patients who underwent thyroidectomy for confirmed PTMC based on a final histological examination between January 2014 and June 2015. Based on the presence of LNM, 521 cases were divided into two groups: metastasis (218) and non-metastasis (303). Univariate and multivariate logistic regression analyses were used to analyse the US and clinical characteristics of the primary tumour. Results We defined LNM based on the tumour diameter with an optimal critical value of 0.55 cm using ROC analysis with a sensitivity of 65.6% and specificity of 59.6%. We defined US-missed CLNM based on the optimal critical value of 0.65 cm using diagnostic ROC analysis with a sensitivity of 66.0% and specificity of 73.0%. The odds ratios of significant factors with LNM by US were 10.3 (95% confidence interval [95% CI], 6.2-17.0), 5.3 (95% CI, 3.3-8.7), 2.7 (95% CI, 1.1-6.5), 4.3 (95% CI, 1.7-10.5), 2.5 (95% CI, 1.5-4.1), and 2.7 (95% CI, 1.7-4.4) for extrathyroidal invasion, blood flow, multifocality, tumour diameter greater than 0.55 cm, male sex, and age younger than 47 years, respectively. Conclusions US characteristics, such as extrathyroidal invasion, blood flow, tumour diameter, sex, and age, may improve the efficacy of predicting LNM and facilitating diagnosis of PTMC. Furthermore, tumour invasion to the extracapsular thyroid and a diameter greater than 0.65 cm indicate CLNM.
目的 本研究旨在探讨术前超声（US）检查在甲状腺微小乳头状癌（PTMC）患者中预测淋巴结转移（LNM）及漏诊中央区淋巴结转移（CLNM）的危险因素和临床价值。方法 本回顾性研究纳入了2014年1月至2015年6月期间因最终组织学检查确诊为PTMC而接受甲状腺切除术的521例患者。根据有无LNM，将521例患者分为两组：转移组（218例）和非转移组（303例）。采用单因素和多因素logistic回归分析来分析原发肿瘤的超声及临床特征。结果 通过ROC分析，我们以肿瘤直径0.55 cm为最佳临界值定义LNM，其灵敏度为65.6%，特异度为59.6%。通过诊断ROC分析，我们以0.65 cm为最佳临界值定义超声漏诊的CLNM，其灵敏度为66.0%，特异度为73.0%。超声检查显示与LNM相关的显著因素的比值比分别为：甲状腺外侵犯为10.3（95%置信区间[95%CI]，6.2 - 17.0），血流为5.3（95%CI，3.3 - 8.7），多灶性为2.7（95%CI，1.1 - 6.5），肿瘤直径大于0.55 cm为4.3（95%CI，1.7 - 10.5），男性为2.5（95%CI，1.5 - 4.1），年龄小于47岁为2.7（95%CI，1.7 - 4.4）。结论 超声特征，如甲状腺外侵犯、血流、肿瘤直径、性别和年龄，可能提高预测LNM及辅助PTMC诊断的效能。此外，肿瘤侵犯甲状腺包膜外且直径大于0.65 cm提示CLNM。
