Zhao Shanshan, Yue Wenwen, Wang Hui, Yao Jincao, Peng Chanjuan, Liu Xiatian, Xu Dong
Department of Ultrasound, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China.
Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.
J Ultrasound Med. 2023 Feb;42(2):385-398. doi: 10.1002/jum.16024. Epub 2022 May 30.
This study aimed to evaluate conventional ultrasound (US) combined with contrast-enhanced computed tomography (CT) of the neck to predict central lymph node metastasis (CLNM) in clinical lymph-negative patients with papillary thyroid carcinoma (PTC), establish a simple preoperative risk-scoring model, and validate its effectiveness in a two-center dataset.
A total of 423 patients with PTC preoperatively evaluated by US and contrast-enhanced CT were included in the modeling group, and 102 patients from two hospitals were enrolled in the validation group. Independent predictive factors were determined using multivariate logistic regression analysis. Diagnostic performance was evaluated using receiver operating characteristic curve analysis.
The independent predictive factors for CLNM were age ≤45 years (odds ratio [OR] = 3.950), nodule presence in the non-upper pole (OR = 2.385), nodule size >12.5 mm (OR = 2.130), Thyroid Imaging Reporting and Data System score ≥9 (OR = 2.857), normalized enhancement CT value ≥0.75 (OR = 3.132), central enhancement (OR = 0.222), and capsular invasion (OR = 3.478). The area under the curve (AUC) of the model was 0.790 (95% confidence interval [CI]: 0.747-0.834), and the sensitivity and specificity were 70.4% and 73.9%, respectively. The AUC in the validation group was 0.827 (95% CI: 0.747-0.907), and the sensitivity and specificity were 88.9% and 63.2%, respectively.
We found conventional US combined with contrast-enhanced CT of the neck to be useful in predicting CLNM preoperatively and established a simple risk-scoring model that might help surgeons with appropriate surgical plans and prognostic evaluation.
本研究旨在评估颈部传统超声（US）联合对比增强计算机断层扫描（CT），以预测临床淋巴结阴性的甲状腺乳头状癌（PTC）患者的中央淋巴结转移（CLNM），建立一个简单的术前风险评分模型，并在双中心数据集中验证其有效性。
建模组纳入423例术前接受超声和对比增强CT评估的PTC患者，验证组纳入来自两家医院的102例患者。使用多因素逻辑回归分析确定独立预测因素。使用受试者工作特征曲线分析评估诊断性能。
CLNM的独立预测因素为年龄≤45岁（比值比[OR]=3.950）、非上极有结节（OR=2.385）、结节大小>12.5mm（OR=2.130）、甲状腺影像报告和数据系统评分≥9（OR=2.857）、增强CT标准化值≥0.75（OR=3.132）、中央增强（OR=0.222）和包膜侵犯（OR=3.478）。该模型的曲线下面积（AUC）为0.790（95%置信区间[CI]：0.747-0.834），敏感性和特异性分别为70.4%和73.9%。验证组的AUC为0.827（95%CI：0.747-0.907），敏感性和特异性分别为88.9%和63.2%。
我们发现颈部传统超声联合对比增强CT有助于术前预测CLNM，并建立了一个简单的风险评分模型，这可能有助于外科医生制定合适的手术方案和进行预后评估。
