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中华医学超声杂志(电子版) ›› 2017, Vol. 14 ›› Issue (10) : 760 -765. doi: 10.3877/cma.j.issn.1672-6448.2017.10.009

所属专题: 文献

浅表器官超声影像学

甲状腺微小乳头状癌原发病变超声特点与颈部大量淋巴结转移的相关性
叶添添1, 夏宇1,(), 姜玉新1, 黄雪培1, 李小毅2, 王亮1, 李文波1, 赖兴建1, 张青1, 杨筱1, 杨萌1, 张波1, 朱庆莉1, 李建初1   
  1. 1. 100730 中国医学科学院 北京协和医学院 北京协和医院超声医学科
    2. 100730 中国医学科学院 北京协和医学院 北京协和医院基本外科
  • 收稿日期:2017-02-13 出版日期:2017-10-01
  • 通信作者: 夏宇
  • 基金资助:
    人事部留学人员科技活动项目(优秀类)(M426300); 国家国际科技合作专项项目(2015DFA30440)

The correlation between the sonographic features of papillary thyroid microcarcinoma and high volume lymph node metastasis

Tiantian Ye1, Yu Xia1,(), Yuxin Jiang1, Xuepei Huang1, Xiaoyi Li2, Liang Wang1, Wenbo Li1, Xingjian Lai1, Qing Zhang1, Xiao Yang1, Meng Yang1, Bo Zhang1, Qingli Zhu1, Jianchu Li1   

  1. 1. Department of Medical Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
    2. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
  • Received:2017-02-13 Published:2017-10-01
  • Corresponding author: Yu Xia
  • About author:
    Corresponding author: Xia Yu, Email:
引用本文:

叶添添, 夏宇, 姜玉新, 黄雪培, 李小毅, 王亮, 李文波, 赖兴建, 张青, 杨筱, 杨萌, 张波, 朱庆莉, 李建初. 甲状腺微小乳头状癌原发病变超声特点与颈部大量淋巴结转移的相关性[J/OL]. 中华医学超声杂志(电子版), 2017, 14(10): 760-765.

Tiantian Ye, Yu Xia, Yuxin Jiang, Xuepei Huang, Xiaoyi Li, Liang Wang, Wenbo Li, Xingjian Lai, Qing Zhang, Xiao Yang, Meng Yang, Bo Zhang, Qingli Zhu, Jianchu Li. The correlation between the sonographic features of papillary thyroid microcarcinoma and high volume lymph node metastasis[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(10): 760-765.

目的

研究甲状腺微小乳头状癌原发病变超声特点与颈部大量淋巴结转移的相关性。

方法

选取2013年10月至2014年11月在北京协和医院就诊的术后经病理证实为甲状腺微小乳头状癌的患者463例,所有患者病例资料完整并有明确颈部淋巴结病理结果。超声观察记录甲状腺微小乳头状癌原发病变结节数目、大小、内部回声、有无钙化、被膜侵犯、血流情况。通过多因素分析寻找中央组及侧方组颈部淋巴结大量转移的超声相关危险因素。中央组及侧方组影响淋巴结大量转移的潜在危险因素的单因素分析采用χ2检验或Fisher精确概率检验。多因素采用Logistic回归分析危险因素与因变量的相关性。

结果

中央组大量淋巴结转移24例(5.2%,24/463),单因素分析中,男性与女性(11.2% vs 3.4%)、年龄<45岁与年龄≥45岁(8.3% vs 2.4%)、微小钙化与粗大钙化、混合钙化及无钙化(8.3%、0.0%、3.2%、0.7%)、有被膜侵犯与无被膜侵犯(9.3% vs 3.2%)、最大径>7 mm与≤7 mm者(9.2% vs 2.5%)淋巴结大量转移比较,差异均有统计学意义(P均<0.01);多因素分析中男性(OR=3.205,P=0.009)、年龄<45岁(OR=2.923,P=0.031)、微小钙化(OR=9.380,P=0.031)及肿物最大径≥7 mm(OR=3.272,P=0.013)为甲状腺微小乳头状癌中央组淋巴结大量转移的独立危险因素。侧方组大量淋巴结转移10例(2.2%,10/463),单因素分析中,年龄<45岁和年龄≥45岁(4.1% vs 0.4%)、癌灶多发和癌灶单发(5.3% vs 0.9%)淋巴结大量转移比较,差异均有统计学意义(P均<0.01);多因素分析中年龄<45岁(OR=11.939,P=0.024)、癌灶多发(OR=7.247,P=0.007)为侧方组大量淋巴结转移的独立危险因素。

结论

甲状腺微小乳头状癌原发病变超声特点与颈部大量淋巴结转移有相关性。

Objective

To study the correlation between the sonographic features of papillary thyroid microcarcinoma (PTMC) and high volume lymph node metastasis.

Methods

Medical records of 463 PTMC patients were reviewed. Cases of all patients are completed with lymph node metastasis identified by histopathology. Sonographic features such as lesion number, lesion size, echogenicity, calcification, envelope and vascularity of papillary microcarcinoma are recorded. Univariate and multivariate analysis was performed to investigating relationship between sonographic features and high volume lymph node metastasis.

Results

Twenty four patients have high volume central lymph node metastasis (5.2%, 24/463), in univariate analysis, sex (11.2% in male vs 3.4% in female), age (8.3% in <45 years vs 2.4% in ≥45 years) , calcification (8.3% in micro vs 0.0% in coarse, 3.2% in mixed and 0.7% in non) , extracapsular invasion (9.3% with vs 3.2% without) and size (9.2% in ≥7 mm vs 2.5% in <7 mm) showed significant difference; multiple logistic regression analysis showed that male (OR=3.205, P=0.009) , age<45 years (OR=2.923, P=0.031), microcalcification (OR=9.380, P=0.031) and tumor size≥7mm (OR=3.272, P=0.013) is independent risk factor for high volume lymph node metastasis in the central compartment of PTMC. 10 patients have high volume lateral lymph node metastasis (2.2%, 10/463), in univariate analysis, age (4.1% in <45 years vs 0.4% in ≥45 years), number of lesions (5.3% in multiple vs 0.9% in single) showed significant difference; multiple logistic regression analysis showed that age<45 years (OR=11.939, P=0.024) and multiple lesion (OR=7.247, P=0.007) is independent risk factor for high volume lymph node metastasis in the lateral compartment of PTMC.

Conclusion

Sonographic features of primary papillary microcarcinoma of the thyroid has correlation with high volume lymph node metastasis.

表1 甲状腺微小乳头状癌中央组大量淋巴结转移危险因素单因素分析
图3,4 中央组大量淋巴结转移的甲状腺微小乳头状癌患者灰阶超声被膜侵犯及微小钙化声像图(男性,45岁),结节呈低回声。图3示病灶内微小钙化聚集成簇状(箭头所示);图4示病灶处被膜部分连续性中断(箭头所示)
表2 最大长径以5 mm分组PTMC中央组大量淋巴结转移危险因素多因素分析
表3 最大长径以7 mm分组PTMC中央组患者大量淋巴结转移危险因素多因素分析
表4 PTMC侧方组患者大量淋巴结转移危险因素单因素分析
表5 PTMC侧方组患者大量淋巴结转移危险因素多因素分析
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