摘要
目的 探讨基于超声联合甲状腺激素水平的列线图鉴别甲状腺微小乳头状癌(PTMC)的临床价值。方法 选择经手术病理诊断证实原发性PTMC患者216例(316个病灶),其中男性165例,女性51例;年龄18~71岁,平均年龄42.29岁;病灶直径范围中,横径5.2~28.5 mm,平均横径19.23 mm,纵径4.6~27.4 mm,平均纵径16.63 mm。采用荷兰PHILIPS EPIQ 5C超声诊断仪行超声检查和病理诊断。按病理诊断结果分组。采用t检验或χ~2/Fisher检验分析两组患者临床病理资料、超声影像特征的差异。使用二分类Logistic回归分析筛选出诊断PTMC的独立危险因素,并制作列线图可视化危险因素对PTMC的诊断效能。结果 216例患者中,恶性组(恶性结节)124例(189个病灶)和良性组(良性结节)92例(127个病灶)。结节叶内位置、结节大小和纵横比(A/T)、多灶性、形态、边界、边缘、回声、钙化和甲状腺球蛋白(TG)在恶性组与良性组之间差异有统计学意义(P <0.05)。通过Logistic回归分析,A/T、边缘、多灶性、TG是诊断PTMC的独立风险因素。基于独立风险因素(A/T> 0.85,边缘不光整,存在多灶性,TG≥9.86μg/mL)构建的诊断PTMC的列线图的受试者操作特性(ROC)曲线下面积为0.861,灵敏度为75.13%,特异度为87.40%。A/T单一因素诊断PTMC的AUC为0.847,灵敏度为73.55%,特异度为91.34%;其诊断效能与联合诊断相比,差异无显著统计学意义,但显著高于其他单一因素。结论 基于超声联合甲状腺激素水平的列线图构建甲状腺良恶性结节鉴别诊断模型可作为一种无创性量化工具,尤其是结节A/T> 0.85可作为诊断PTMC的重要特异性征象,可显著减少PTMC的漏诊率,更有利于术前甲状腺手术治疗策略的制定。
Objective To explore the clinical values of nomogram based on sonography and thyroid hormone for differentiating papillary thyroid microcarcinoma(PTMC) in thyroid nodules. Methods A total of 216 PTMC patients(316 lesions) patho logically confirmed after surgery were enrolled, which included 165 males and 51 females, aged 18-71 years old with mean age of 42.29 years old;transverse diameter was 5.2-28.5 mm with mean transverse diameter of 19.23 mm, and longitudinal diameter was 4.6-27.4 mm with mean longitudinal diameter of 16.63 mm. All patients performed ultrasound examination using PHILIPS EPIQ 5C ultrasound diagnostic instrument and pathologic diagnosis was examinated. Groups was divided according to pathological diagnosis results. The differences of clinicopathological data and ultrasound imaging features between 2groups were analyzed by t test or χ~2/Fisher test. The binary Logistic regression analysis was used to screen out independent risk factors for diagnosis of PTMC, and the nomogram was made to visualize diagnostic efficacy of risk factors for PTMC. Results Among 216 patients, 124 were malignancies(malignant group, 189 lesions) and 92 were benignities(benign group, 127 lesions).There were significant differences in intranodular location, nodule size and aspect ratio( A/T), multifocality, morphology,boundary, margin, echo, calcification and thyroglobulin(TG) between 2 groups(P<0.05). The Logistic regression analysis showed that A/T ratio, margin, multifocality and TG were independent risk factors for the diagnosis of PTMC(P<0.05). The area under receiver operating characteristic(ROC) curve of nomogram for diagnosis of PTMC based on independent risk factors(A/T> 0.85, unsmooth margin with multifocal, TG ≥ 9.86 μg/mL) was 0.861, sensitivity was 75.13 %, and specificity was 87.40 %. The AUC of A/T in diagnosis of PTMC was 0.847, sensitivity was 73.55 %, and specificity was 91.34 %. The diagnostic efficacy of A/T was no significantly different with that of combined diagnosis, but it was significantly higher than that of other single factors(P<0.05). Conclusion It is demonstrated that differential diagnosis model of benign and malignant thyroid nodules based on ultrasound combined with thyroid hormone level could be used as non-invasive quantitative tool. Especially, the A/T> 0.85 could be used as an important specific sign for diagnosis of PTMC, which could significantly reduce the missed diagnosis rate of PTMC, and is more conducive to formulate preoperative thyroid surgery treatment strategy.
作者
单思维
刘从兵
高天奇
SHAN Si-wei;LIU Cong-bing;GAO Tian-qi(Department of Ultrasound,Suqian Hospital Afiliated zhou Medical University,Suqiann223865,Jiangsu,China)
出处
《生物医学工程与临床》
CAS
2023年第4期452-459,共8页
Biomedical Engineering and Clinical Medicine
基金
宿迁市指导性科技计划项目(Z2021105)。
关键词
甲状腺
超声
微小乳头状癌
风险因素
列线图
thyroid
ultrasound
papillary thyroid microcarcinoma(PTMC)
risk factors
nomogram
