摘要
目的探讨实时剪切波弹性成像(SWE)对甲状腺乳头状癌患(PTC)者淋巴结转移的预测价值及影响因素。方法选取101例PTC患者,术前均接受常规二维超声及SWE检查,比较淋巴结转移与未转移患者的SWE定量参数——杨氏模量值(E),包括E_(min)、E_(max)和E_(mean)。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),以术后病理学检查结果为金标准,评估SWE定量参数对PTC患者淋巴结转移的预测价值;PTC患者淋巴结转移的影响因素采用多因素Logistic回归分析。结果101例患者中,淋巴结转移36例,淋巴结未转移65例。淋巴结转移PTC患者的E_(max)、E_(mean)均明显高于未转移患者,差异均有统计学意义(P﹤0.01);两组患者E_(min)比较,差异无统计学意义(P﹥0.05)。ROC曲线显示,E_(max)、E_(mean)均对PTC淋巴结转移具有较高的预测价值,E_(max)预测PTC患者淋巴结转移的AUC为0.883(95%CI:0.817~0.949),cut-off值为43.35 k Pa,灵敏度为84.6%,特异度为73.2%;E_(mean)预测PTC患者淋巴结转移的AUC为0.829(95%CI:0.751~0.908),cut-off值为30.15 k Pa,灵敏度为82.1%,特异度为54.8%。多因素Logistic回归分析结果显示,多发病灶、病灶与被膜接触≥25%、E_(max)﹥43.35 k Pa均是PTC患者淋巴结转移的独立危险因素(P﹤0.05)。结论SWE对PTC患者淋巴结转移的预测价值优于常规二维超声检查,多发病灶、病灶与被膜接触≥25%、E_(max)﹥43.35 k Pa均是PTC患者淋巴结转移的独立危险因素,明显提高了PTC患者淋巴结转移的术前诊断价值,为选择合适的手术方案提供了指导。
Objective To investigate the predictive value and influencing factors of real-time shear wave elastography(SWE)for lymph node metastasis in patients with papillary carcinoma of the thyroid(PTC).Method A total of 101 patients with PTC were selected,all patients received conventional two-dimensional ultrasound and SWE examination.The SWE Young’s modulus(E),including E_(min),E_(max) and E_(mean) were compared between the patients with and without lymph node metastasis.Receiver operating characteristic(ROC)curve was plotted and the area under the curve(AUC)was calculated to evaluate the predictive value of SWE quantitative parameters for lymph node metastasis in PTC patients by using postoperative pathological examination as the gold standard.The influencing factors of lymph node metastasis in PTC patients were analyzed by multivariate Logistic regression.Result A total of 36 patients had lymph node metastasis and 65 had no lymph node metastasis in 101 patients.The E_(max) and E_(mean) of PTC patients with lymph node metastasis were higher than those without lymph node metastasis(P<0.01),but there was no significant difference in E_(min)(P>0.05).The ROC curve showed that E_(max) and E_(mean) had higher predictive value for lymph node metastasis in PTC patients.The AUC of E_(max) for predicting lymph node metastasis in PTC patients was 0.883(95%CI:0.817-0.949),with cut-off value was 43.35 kPa,the sensitivity was 84.6%and specificity the 73.2%,and the AUC of E_(mean) was 0.829(95%CI:0.751-0.908),with cut-off value was 30.15 kPa,the sensitivity was 82.1%,and specificity was 54.8%.Multivariate Logistic regression analysis showed that the presence of multiple foci,capsule invasion≥25%,and E_(max)>43.35 kPa were independent risk factors for lymph node metastasis in PTC patients(P<0.05).Conclusion The predictive value of SWE for lymph node metastasis in PTC patients is superior to conventional two-dimensional ultrasound examination,which significantly improves the preoperative diagnostic value of lymph node metastasis in PTC patients,and provides guidance for selection of appropriate surgical plan.The presence of multiple foci,capsule invasion≥25%,and E_(max)>43.35 kPa are independent risk factors for lymph node metastasis in PTC patients.
作者
张云霞
陈欣
刘宏雄
ZHANG Yunxia;CHEN Xin#;LIU Hongxiong(Department of Ultrasound,Yulin No.2 Hospital,Yulin 719000,Shaanxi,China)
出处
《癌症进展》
2023年第19期2174-2177,共4页
Oncology Progress
基金
陕西省社会发展科技攻关项目(2016LL04-3-217)。
关键词
常规二维超声
实时剪切波弹性成像
甲状腺乳头状癌
淋巴结转移
预测价值
conventional two-dimensional ultrasound
real-time shear wave elastography
papillary carcinoma of the thyroid
lymph node metastasis
predictive value
