目的：探讨CT平扫瘤体与甲状腺边缘接触程度对甲状腺乳头状癌（Papillary thyroid carcinoma，PTC）中央组淋巴结转移（Central lymph node metastasis，CLNM）的预测价值。方法：回顾性分析经手术和病理证实的207例单发PTC，其中CLNM阳性和阴性分别为104例和103例。根据CT征象中瘤体与甲状腺边缘接触范围的不同，将其分为<1/4组、1/4~＜1/2组和≥1/2组，采用χ2检验分析CLNM阳性和阴性在3组中的分布差异，并计算<1/4组、1/4~＜1/2组、≥1/2组和1/4~＜1/2组联合≥1/2组（即≥1/4组）对CLNM阳性预测的敏感度、特异度、阳性预测值、阴性预测值和准确度。结果：χ2检验显示，CLNM阳性和阴性在<1/4组、1/4~＜1/2组和≥1/2组具有统计学差异（χ2=14.540，P<0.05），3组间进一步两两比较显示，CLNM阳性和阴性在<1/4组和1/4~＜1/2组（χ2=9.514，P<0.012 5）、<1/4组和≥1/2组（χ2=13.715，P<0.012 5）具有统计学差异，1/4~＜1/2组和≥1/2组不具有统计学差异（χ2=0.752，P>0.012 5）。单个风险因素中，瘤体与甲状腺边缘接触范围≥1/4时的敏感度（88%）和准确度（61%）最高，与甲状腺边缘接触范围≥1/2时的特异度最高（72%）。结论：PTC与甲状腺边缘接触程度可以在很大程度上对CLNM是否阳性进行预测，当边缘接触范围≥1/4时的敏感度和准确度最高。
Abstract
Objective: To investigate the value of using CT sign “thyroid marginal contact” of papillary thyroid carcinoma(PTC) to predict the central lymph node metastasis(CLNM). Methods: This article reviewed 207 patients with surgically and pathologically verified PTC, among the patients, 104 patients with CLNM, and 103 patients without CLNM. According to the area of thyroid marginal contact, divided the patients into three groups: <1/4 group, 1/4~<1/2 group and ≥1/2 group. The data was analyzed by Chi-square test, and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of <1/4 group, 1/4~<1/2 group，≥1/2 group and 1/4~<1/2 group combined with ≥1/2 group(≥1/4 group) in positive CLNM were calculated. Results: The Chi-square test among multiple groups indicated that there were statistical differences between three groups in CLNM(χ2=14.540, P<0.05). Pairwise comparison with Chi-square test indicated that there was statistical difference between <1/4 group and 1/4~<1/2 group(χ2=9.514, P<0.012 5), <1/4 group and ≥1/2 group(χ2=13.715, P<0.012 5), and there was no statistical difference between 1/4~<1/2 group and ≥1/2 group(χ2=0.752, P>0.012 5). The sensitivity(88%) and the accuracy(61%) of ≥1/4 group were the highest; the specificity of the ≥1/2 group is the highest(72%). Conclusion: The thyroid marginal contact can provide important evidence for the dissection of CLNM. The sensitivity and the accuracy of ≥1/4 group are the highest.
关键词
甲状腺肿瘤 /
癌 /
乳头状 /
肿瘤转移 /
体层摄影术 /
螺旋计算机
Key words
Thyroid neoplasms /
Carcinoma, papillary /
Neoplasm metastasis /
Tomography, spiral computed
中图分类号：
Ｒ736.1
Ｒ730.261
Ｒ814.42
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]张晓红，陈颖，朱丹茹. 超声对甲状腺癌颈部淋巴结转移的诊断价值[J]. 中国当代医药，2013，20（18）：98-99.
[2]谢亚羽. 超声诊断甲状腺乳头状癌转移性淋巴结分析[J]. 浙江中西医结合杂志，2015，25（5）：499-500.
[3]Kutler D, Crummey A, Kuhel W. Routine central compartment lymph node dissection for patients with papillary thyroid carcinoma[J]. Head Neck, 2012, 34(2): 260-263.
[4]Kliseska E, Makovac I. Skip metastases in papillary thyroid cancer[J]. Coll Antropol, 2012, 19(10): 786.
[5]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）：162-205.
[6]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.
[7]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.
[8]Kwak JY, Kim EK, Youk JH, et al. Extrathyroid extension of well-differentiated papillary thyroid microcarcinoma on US[J]. Thyroid, 2008, 18(6): 609-614
[9]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.
[10]Mulla M, Wolfram TK, Gilbert J, et al. Lateral cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging-guided and prophylactic removal of the lateral compartment[J]. Clin Endocrinol, 2012, 77(1): 126-131.
[11]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(2): 385-391.
[12]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, 2013, 271(5): 1215-1218.
[13]瞿佳丽，朱妙平，韩志江. 各种CT征象联合应用在甲状腺微小乳头状癌诊断中的价值[J]. 影像诊断与介入放射学，2015，24（2）：151-155.
[14]朱光兴，盛二燕，杨黎倩. 甲状腺乳头状癌多层螺旋CT诊断与影像分析[J]. 实用医学影像杂志，2015，16（1）：47-49.
[15]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.
[16]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.
[17]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.
基金
杭州市重大科技创新专项项目（20131813A08）；浙江省医药卫生科技计划项目（2015KYB293）。
