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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2023, Vol. 20 ›› Issue (04) : 455 -461. doi: 10.3877/cma.j.issn.1672-6448.2023.04.013

浅表器官超声影像学

被膜侵犯的甲状腺微小乳头状癌发生颈部淋巴结转移的超声相关危险因素分析
李素娟, 丁文波, 武心萍, 邓学东†()   
  1. 210028　南京，江苏省中西医结合医院超声科
    215002　南京医科大学附属苏州医院　苏州市立医院超声中心
  • 收稿日期:2022-09-22 出版日期:2023-04-01
  • 通信作者: 邓学东

Ultrasound-related risk factors for cervical lymph node metastasis of papillary thyroid microcarcinoma with extracapsular invasion

Sujuan Li, Wenbo Ding, Xinping Wu, Xuedong Deng†()   

  1. Department of Ultrasound, Jiangsu Province Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing 210028, China
    Center of Medical Ultrasound, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215002, China
  • Received:2022-09-22 Published:2023-04-01
  • Corresponding author: Xuedong Deng
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李素娟, 丁文波, 武心萍, 邓学东. 被膜侵犯的甲状腺微小乳头状癌发生颈部淋巴结转移的超声相关危险因素分析[J]. 中华医学超声杂志（电子版）, 2023, 20(04): 455-461.

Sujuan Li, Wenbo Ding, Xinping Wu, Xuedong Deng. Ultrasound-related risk factors for cervical lymph node metastasis of papillary thyroid microcarcinoma with extracapsular invasion[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(04): 455-461.

目的

探讨被膜侵犯的甲状腺微小乳头状癌（PTMC）发生颈部淋巴结转移的超声相关危险因素。

方法

回顾性选取2015年1月至2021年12月在江苏省中西医结合医院行手术治疗、最终经手术病理证实的存在被膜侵犯的单灶性PTMC患者共计94例，依据术后组织病理学结果，将患者分为颈部淋巴结转移组48例和对照组（无颈部淋巴结转移组）46例。纳入结节均进行术前常规二维超声、超声弹性成像及超声造影检查，常规扫查颈部淋巴结。对淋巴结转移组与无淋巴结转移组的临床及超声特征进行单因素分析，将单因素分析有统计学意义的特征纳入多因素Logistic回归分析，得出被膜侵犯PTMC淋巴结转移的独立危险因素。

结果

对淋巴结转移组与无淋巴结转移组的性别、年龄、是否合并桥本甲状腺炎、结节最大直径、纵横比（A/T）、与被膜接触范围及微钙化、弹性评分进行单因素分析。单因素分析结果显示，淋巴结转移组与无淋巴结转移组是否存在微钙化差异有统计学意义（P＜0.05），与被膜接触范围2组比较差异有统计学意义（P=0.001）。多因素Logistic回归分析结果显示，被膜接触范围＞50%与微钙化灶均为单灶被膜侵犯PTMC淋巴结转移的独立危险因素（OR=8.401，95%CI：2.554~27.640，P＜0.001；OR=8.039，95%CI：2.670~24.209，P＜0.001）。

结论

多种模式联合应用的超声声像图在预测被膜侵犯的PTMC是否存在颈部淋巴结转移方面具有重要价值。微钙化、肿瘤与甲状腺被膜接触范围对PTMC患者是否存在颈部淋巴结转移具有一定预测价值。

关键词: 甲状腺乳头状癌, 超声检查, 淋巴结转移, 被膜侵犯
Objective

To identify the risk factors for cervical lymph node metastasis of papillary thyroid microcarcinoma (PTMC) with extracapsular invasion.

Methods

A total of 94 patients with unifocal PTMC with extracapsular invasion who underwent surgical treatment at the Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine from January 2015 to December 2021 and were finally confirmed by surgical pathology were retrospectively selected and divided into either a cervical lymph node metastasis group (48 patients) or a no cervical lymph node metastasis group (control group; 48 patients) based on postoperative histopathological findings. All included nodes underwent routine preoperative 2D ultrasound, ultrasound elastography, and ultrasonography, and the cervical lymph nodes were routinely scanned. The clinical and ultrasound characteristics of patients in the the two groups were analysed univariately, and the characteristics with statistical significance in the univariate analysis were included in multivariate logistic regression analysis to indentify independent risk factors for cervical lymph node metastasis of PTMC with extracapsular invasion.

Results

Univariate analysis was performed on gender, age, presence of combined Hashimoto's thyroiditis, maximum nodule diameter, aspect ratio (A/T), extent of contact with the capsule, microcalcifications, and elasticity score in the lymph node metastasis group versus the no lymph node metastasis group. The results of the univariate analysis showed that there was a statistically significant difference between the lymph node metastasis group and the no lymph node metastasis group for the presence of microcalcifications (P＜0.05) and the extent of contact with the capsule (P=0.001). Multivariate logistic regression analysis showed that microcalcification foci, and the extent of contact with the capsule of >50% were independent risk factors for lymph node metastasis in unifocal PTMC with extracapsular invasion (odds ratio [OR]=8.401, 95% confidence interval [CI]: 2.554-27.640, P＜0.001; OR=8.039, 95%CI: 2.670-24.209, P＜0.001).

Conclusions

Multimodal ultrasound images have important value in predicting cervical lymph node metastasis in PTMC with extracapsular invasion. Microcalcification, and the tumor contact range with the adjacent capsule of the thyroid have excellent value in predicting lymph node metastasis for PTMC patients.

Key words: Papillary thyroid carcinoma, Ultrasonography, Lymph node metastasis, Extracapsular invasion
图1 甲状腺被膜连续性中断超声图像
图2 结节纵横比A/T≥1及A/T＜1超声图像。图a为结节纵横比A/T≥1；图b为结节纵横比A/T＜1
图3 甲状腺结节内多发及单发微钙化超声图像。图a为结节内多发微钙化；图b为结节内单发微钙化
图4 甲状腺结节与被膜接触超声图像。图a为甲状腺结节与被膜接触范围＜20%；图b为甲状腺结节与被膜接触范围20%~50%；图c为甲状腺结节与被膜接触范围＞50%
图5 转移性淋巴结超声图像。图a为淋巴结内可见囊化区；图b为淋巴结内可见微钙化灶
表1 淋巴结转移组与无淋巴结转移组的临床及超声特征单因素分析［例（%）］
因素 淋巴结转移组（n=48） 无淋巴结转移组（n=46） χ2值 P值
年龄 3.406 0.065
＜45岁 31（64.5） 21（45.6）
≥45岁 17（35.5） 25（54.4）
性别 1.394 0.238
男 12（25.0） 7（15.2）
女 36（75.0） 39（84.8）
合并桥本氏甲状腺炎 1.574 0.210
是 12（25.0） 17（36.9）
否 36（75.0） 29（73.1）
结节最大直径 1.023 0.312
≤5mm 16（33.3） 20（43.4）
＞5mm 32（63.7） 26（56.6）
微钙化 9.993 0.002
有 38（79.1） 22（47.8）
无 10（20.9） 24（52.2）
纵横比A/T 0.765 0.382
≥1 40（83.3） 35（76.1）
＜1 8（16.7） 11（23.9）
与被膜接触范围 13.487 0.001
＜25% 8（16.6） 20（43.4）
25%~50% 10（20.9） 14（30.5）
＞50% 30（62.5） 12（26.1）
弹性评分 2.340 0.310
Ⅱ分 18（37.5） 23（50.0）
Ⅲ分 20（41.7） 18（39.1）
Ⅳ分 10（20.8） 5（10.2）
表2 单灶被膜侵犯PTMC淋巴结转移的多因素Logistic回归分析
因素 回归系数 标准误 Wald值 P值 OR值 95%CI
与被膜接触范围＞50% 2.128 0.608 12.271 ＜0.001 8.401 2.554~27.640
钙化 2.084 0.562 13.733 <0.001 8.039 2.670~24.209
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