Sun Kemin, He Xiuli, Guo Lingling
Department of Ultrasound,First Affiliated Hospital of Jinzhou Medical University,Jinzhou,121000,China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Mar;35(3):260-263. doi: 10.13201/j.issn.2096-7993.2021.03.015.
To investigate the clinical and ultrasonic features of papillary thyroid microcarcinoma (PTMC) and the risk factors of central lymph node metastasis (CLNM), to provide help for individualized treatment. One hundred and eighty-five patients with PTMC confirmed by surgery and pathology and underwent prophylactic CLN dissection were retrospectively analyzed. According to lymph node metastasis, patients were divided into metastasis group and non metastasis group. The size, shape, echo, aspect ratio, edge, protruding capsule, nodule location, calcification and calcification were analyzed. The relationship between clnm and ultrasonographic features, sex, age, single/multiple, whether or not with Hashimoto thyroiditis was analyzed. Among 185 patients with PTMC, 55 cases had lymph node metastasis, and the metastasis rate was 30.0%. In univariate analysis, clnm of PTMC was significantly correlated with gender, age, tumor size, protruding capsule, type of calcification and single / multiple (all <0.05). In multivariate logistic regression analysis, tumor size, single/multiple, protruding capsule, gender and age were the risk factors of clnm. According to the ROC curve, when the age was 49.5 years old and the mass size was 4.8 mm, the diagnostic test yoden index reached the maximum value. When the risk factors of male, ≤49.5 years old, tumor size≥4.8 mm, multiple and protruding capsule appeared in PTMC patients, preventive CLN clearance should be taken actively.
探讨甲状腺微小乳头状癌(PTMC)的临床及超声特征以及中央区淋巴结转移(CLNM)的危险因素,为个体化治疗提供帮助。回顾性分析185例经手术及病理证实为PTMC并接受预防性中央区淋巴结清扫术的患者。根据淋巴结转移情况,将患者分为转移组和非转移组。分析肿瘤的大小、形态、回声、纵横比、边界、包膜外凸、结节位置、钙化情况等。分析CLNM与超声特征、性别、年龄、单发/多发、是否合并桥本甲状腺炎之间的关系。185例PTMC患者中,55例发生淋巴结转移,转移率为30.0%。单因素分析显示,PTMC的CLNM与性别、年龄、肿瘤大小、包膜外凸、钙化类型及单发/多发均显著相关(均P<0.05)。多因素logistic回归分析显示,肿瘤大小、单发/多发、包膜外凸、性别及年龄是CLNM的危险因素。根据ROC曲线,年龄49.5岁、肿块大小4.8 mm时,诊断试验约登指数达最大值。PTMC患者出现男性、年龄≤49.5岁、肿瘤大小≥4.8 mm、多发及包膜外凸等危险因素时,应积极行预防性中央区淋巴结清扫。