目的：探讨CT征象联合临床特征对颈淋巴结临床阴性（clinical stage N0，cN0）单发甲状腺乳头状癌（PTC）中央组淋巴结转移（CLNM）的预测价值。方法：回顾经手术和病理证实的390例cN0期单发PTC的CT征象及临床特征，通过受试者工作特征（ROC）曲线确定PTC直径的阈值，采用单因素和多因素Logistic回归分析瘤体位置、甲状腺边缘接触、钙化、平扫边界、增强后边界、直径、年龄、性别与CLNM的关系，计算单个和多个风险因素联合在CLNM阳性中的敏感度和特异度。结果：390例cN0期单发PTC中，CLNM阳性和阴性分别为109例和281例。ROC曲线示直径=0.7 cm时，约登指数最大。单因素分析表明甲状腺边缘接触、直径、年龄和性别与CLNM阳性相关，其中甲状腺边缘接触、直径＞0.7 cm、年龄＜45岁和男性在CLNM中更常见（P<0.05）。多因素Logistic回归分析进一步表明甲状腺边缘接触、年龄＜45岁和男性与CLNM阳性相关，而直径与CLNM无关。单个风险因素的敏感度和特异度分别为30%~85%和34%~83%，两个或三个风险因素联合的敏感度和特异度分别为12%~49%和74%~94%。结论：甲状腺边缘接触、年龄＜45岁和男性是CLNM阳性的独立风险因素，多个风险因素联合可显著提高术前诊断的特异度，为cN0期单发PTC中央组淋巴结清扫提供重要的依据。
Abstract
Objective: To investigate the predictive value of CT combined with clinical features in diagnosing central lymph node metastasis of papillary thyroid carcinoma in stage cN0. Methods: The CT signs and clinical features of 390 cases of PTC confirmed by surgery and pathology were reviewed. The threshold of PTC diameter was identified by ROC. The location of tumor, thyroid edge contact, calcification, boundary on plain scan, boundary on enhanced scan, diameter, age, gender and relation with CLNM were analyzed by univariate and multivariate logistic regression method. The sensitivity and specificity of single factor and combined multiple risk factors in positive CLNM were calculated. Results: Among 390 cases of PTC in stage cN0, there were 109 cases of CLNM positive and 281 cases of CLNM negative. ROC curve showed that when the diameter=0.7 cm, the Youden index is maximum. Univariate analysis indicated that thyroid edge contact, diameter, age and gender were correlated with CLNM positive, of which, thyroid edge contact, diameter >0.7 cm, age <45 years and men were more common in CLNM(P<0.05). Multivariate logistic regression analysis further indicated that thyroid edge contact, age <45 years and men were associated with CLNM positive, while diameter was not associated with CLNM. The sensitivity and specificity of individual risk factor were 30%~85% and 34%~83% respectively. The sensitivity and specificity of combination of two or more risk factors were 12%~49% and 74%~94%, respectively. Conclusion: The individual risk factors of CLNM positive are thyroid edge contact, age <45 years, and men. The combination of multiple risk factors can significantly enhance the specificity of preoperative diagnosis, providing important basis for lymphadenectomy of PTC in stage cN0.
关键词
甲状腺肿瘤 /
癌 /
乳头状 /
淋巴转移 /
体层摄影术 /
螺旋计算机
Key words
Thyroid neoplasms /
Carcinoma, papillary /
Lymphatic metastasis /
Tomography, spiral computed
中图分类号：
Ｒ736.1
Ｒ730.261
R814.42
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参考文献
[1]Hughes DT, Haymart MR, Miller BS, et al. The most commonly occurring papillary thyroid cancer in the United States is now a microcarcinoma in a patient older than 45 years[J]. Thyroid, 2011, 21(3): 231-236.
[2]Mizrachi A, Feinmesser R, Bachar G, et al. Value of ultrasound in detecting central compartment lymph node metastases in differentiated thyroid carcinoma[J]. Eur Arch Otorhinolaryngol, 2014, 271(5): 1215-1218.
[3]林启强，韩志江，舒艳艳，等. CT在评估甲状腺乳头状癌中央组淋巴结转移中的价值[J]. 中国临床医学影像杂志，2015，26（3）：162-165.
[4]Choi YJ, Yun JS, Kook SH, et al. Clinical and imaging assessment of cervical lymph node metastasis in papillary thyroid carcinomas[J]. World J Surg， 2010， 34(7): 1494-1499.
[5]Wang Q, Chu B, Zhu J, et al. Clinical analysis of prophylactic central neck dissection for papillary thyroid carcinoma[J]. Clin Transl Oncol, 2014, 16(1): 44-48.
[6]Wu Y, Gu J, Shang J, et al. Central lymph node metastasis in cN0 papillary thyroid carcinoma[J]. J BUON, 2013, 18(3): 733-738.
[7]Sun W, Lan X, Zhang H, et al. Risk Factors for Central Lymph Node Metastasis in CN0 Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis[J]. PLoS One, 2015, 10(10): e0139021.
[8]韩志江，陈文辉，周健，等. CT在微小甲状腺癌诊断中的价值[J]. 中华放射学杂志，2012，46（2）：135-138.
[9]Han ZJ, Shu YY, Lai XF, et al. Value of computed tomography in determining the nature of papillary thyroid microcarcinomas: evaluation of the computed tomographic characteristics[J]. Clin Imaging, 2013, 37(4): 664-668.
[10]朱妙平，周秀艳，韩志江，等. 不同CT征象及其联合应用在甲状腺乳头状癌诊断中的价值[J]. 中国临床医学影像杂志，2014，25（12）：840-843.
[11]Carty SE, Cooper DS, Doherty GM, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer[J]. Thyroid, 2009, 19(11): 1153-1158.
[12]Choi JS, Kim J, Kwak JY, et al. Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT[J]. AJR, 2009, 193(3): 871-878.
[13]Kim KE, Kim EK, Yoon JH, et al. Preoperative Prediction of Central Lymph Node Metastasis in Thyroid Papillary Microcarcinoma Using Clinicopathologic and Sonographic Features[J]. World J Surg, 2013, 37(1): 385-391.
[14]Zhan WW, Zhou P, Zhou JQ, et al. Differences in sonographic features of papillary thyroid carcinoma between neck lymph node metastatic and nonmetastatic groups[J]. J Ultrasound Med, 2012, 31(6): 915-920.
[15]Wang W, Gu J, Shang J, et al. Correlation analysis on central lymph node metastasis in 276 patients with cN0 papillary thyroid carcinoma[J]. Int J Clin Exp Pathol, 2013, 6(3): 510-515.
基金
2015年浙江省医药卫生计划项目（2015KYB293）；2013年杭州市重大科技创新专项项目（20131813A08）； 2012年杭州市卫生科技计划项目（2012A020）。
