CT预测甲状腺微小乳头状癌中央区淋巴结转移价值

田江雨; 谭志巍

doi:10.15953/j.1004-4140-2023.32.01.10

CT预测甲状腺微小乳头状癌中央区淋巴结转移价值

doi: 10.15953/j.1004-4140-2023.32.01.10

田江雨^1, ,,
谭志巍^2,

1.
成都市第三人民医院放射科, 成都610000
2.
核工业四一六医院病理科, 成都610000

基金项目: 成都医学院校基金（CYZ18-14）。

详细信息

作者简介:
田江雨：男，成都市第三人民医院医师，主要从事头颈影像诊断及相关临床研究工作，E-mail：tjydoc@163.com

通讯作者:
田江雨

中图分类号: R 814
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- 文章访问数: 148
- HTML全文浏览量: 53
- PDF下载量: 14
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-04
- 网络出版日期: 2022-02-28
- 刊出日期: 2023-01-31

Evaluation of CT in Predicting Central Lymph Node Metastasis of Papillary Thyroid Microcarcinoma

TIAN Jiangyu^{1
, ,},
TAN Zhiwei^2
,

1.
Department of Radiology, the Third People's Hospital of Chengdu, Chengdu 610000, China
2.
Department of Pathology, China National Nuclear Corporation 416 Hospital, Chengdu 610000, China

摘要

摘要: 目的：明确CT在预测甲状腺微小乳头状癌（PTMC）中央区淋巴结转移（CLNM）中的价值。方法：选取成都市第三人民医院157例经病理证实的PTMC患者，回顾分析患者的CT及临床病理资料，受试者工作特征曲线（ROC曲线）得出PTMC长径预测CLNM的最佳截断值，通过CT及临床病理资料建立PTMC CLNM的二元logistic回归模型，并通过ROC曲线评价模型的诊断价值。结果：ROC曲线得出预测PTMC CLNM的最佳截断值为6 mm；单因素分析：咬饼征、微钙化、多灶癌、PTMC长径≥6 mm、男性、年龄<45岁是PTMC CLNM的危险因素；二元Logistic回归分析：咬饼征伴突出（OR=5.159，95％ CI=1.137～23.400）、多灶癌（OR=2.734，95％ CI=1.215～6.154）、PTMC长径≥6 mm（OR=3.259，95％ CI=1.326～8.008）、男性（OR=3.776，95％ CI=1.339～10.653）、年龄<45岁（OR=3.222，95％ CI=1.419～7.777）是PTMC CLNM的独立危险因素；ROC曲线得出，约登指数=0.502时，诊断CLNM的敏感性、特异性分别为82.5％和68.0％。结论：二元Logistic回归模型有助于预测PTMC CLNM；咬饼征伴突出、PTMC≥6 mm、男性、年龄<45岁是PTMC CLNM的独立危险因素。对于上述类型患者，外科医师可考虑中央区淋巴结清扫。
- 计算机体层成像 /
- 甲状腺微小乳头状癌 /
- Logistic回归分析
Abstract: Objective: To determine the value of CT in predicting CLNM in PTMC. Methods: 157 patients with PTMC confirmed by pathology in our hospital were enrolled, and the CT and clinicopathological data of the patients were retrospectively analyzed. ROC curve was used to determine the optimal cutoff value of PTMC greatest diameter for CLNM. The binary logistic regression model of PTMC CLNM was established based on CT and clinical pathological data, and the diagnostic value of the model was evaluated by ROC curve. Results: According to the ROC curve, the optimal cutoff value for predicting PTMC CLNM was 6 mm. Univariate analysis: Cookie bite sign , microcalcification, multifocality, PTMC greastest diameter ≥6 mm, male, Age<45 were risk factors for PTMC CLNM. Binary Logistic regression analysis: Cookie bite sign with protruding (OR=5.159, 95% CI=1.137 ~ 23.400), multifocality (OR=2.734, 95% CI=1.215 ~ 6.154), PTMC greastest diameter ≥6 mm (OR=3.259, 95% CI=1.326 ~ 8.008), male (OR=3.776, 95% CI=1.339 ~ 10.653), age <45 (OR=3.222, 95% CI=1.419 ~ 7.777), were independent risk factors for PTMC CLNM. According to the ROC curve, when the Youden index=0.502, the sensitivity and specificity in predicting CLNM were 82.5% and 68.0%, respectively. Conclusion: The binary logistic regression model is helpful in predicting PTMC CLNM. Cookie bite sign with protruding, PTMC greastest diameter≥6 mm, male, and age<45 were independent risk factors for PTMC CLNM. For this type of patients, we suggest that surgeons should consider central lymph node dissection.
- computed tomograph /
- papillary thyroid microcarcinoma /
- logistic regression analysis

HTML全文

图 1 53岁女性，甲状腺右侧叶结节无咬饼征（黑箭头），病理结果：PTMC不伴CLNM

Figure 1. Female, 53 years old，the nodule in the right thyroidal lobe without cookie bite sign (black arrow). Pathological results: PTMC without CLNM

下载: 全尺寸图片幻灯片

图 2 45岁女性，甲状腺右侧叶结节咬饼征不伴突出（黑箭头），病理结果提示PTMC不伴CLNM

Figure 2. Female, 45 years old, the nodule in the right thyroidal lobe with cookie bite sign without protruding (black arrow). Pathological results: PTMC without CLNM

下载: 全尺寸图片幻灯片

图 3 52岁男性，甲状腺右侧叶结节咬饼征伴突出（黑箭头），病理结果提示PTMC伴CLNM

Figure 3. Male, 53 years old, the nodule in the right thyroidal lobe with cookie bite sign with protruding (black arrow). Pathological results: PTMC CLNM

下载: 全尺寸图片幻灯片

图 4 34岁女性，甲状腺右侧叶结节咬饼征伴突出（黑箭头），病理结果提示PTMC伴CLNM

Figure 4. Female, 34 years old, the nodule in the right thyroidal lobe with cookie bite sign with protruding (black arrow). Pathological results: PTMC CLNM

下载: 全尺寸图片幻灯片

表 1 PTMC CLNM的单因素分析结果

Table 1. The result of Univariate analysis in PTMC CLNM

项目	特征	CLNM		统计检验
项目	特征	是	否	χ²	P
咬饼征	咬饼征伴突出	32	28	14.119	0.001
	咬饼征不伴突出	21	49
	无咬饼征	4	23
增强后边界模糊	是	43	79	0.266	0.606
增强后边界模糊	否	14	21	0.266	0.606
微钙化	是	24	21	7.909	0.006
微钙化	否	33	79	7.909	0.006
多灶癌	是	34	27	16.290	<0.001
多灶癌	否	23	73	16.290	<0.001
长径≥6 mm	是	47	45	20.995	<0.001
长径≥6 mm	否	10	55	20.995	<0.001
PTMC位置	甲状腺上叶	28	51	0.175	0.916
	甲状腺下叶	24	42
	甲状腺峡部	5	7
性别	男	18	17	4.455	0.046
性别	女	39	83	4.455	0.046
年龄<45岁	是	44	48	12.754	<0.001
年龄<45岁	否	13	52	12.754	<0.001

下载: 导出CSV

表 2 PTMC CLNM的二元Logistic回归分析结果

Table 2. The result of binary Logistic regression analysis in PTMC CLNM

项目	β	P	OR	OR 95% CI
项目	β	P	OR	下限	上限
微钙化	0.669	0.122	1.952	0.836	4.554
多灶癌	1.006	0.015	2.734	1.215	6.154
长径≥6 mm	1.181	0.010	3.259	1.326	8.008
男性	1.329	0.012	3.776	1.339	10.653
年龄<45岁	1.201	0.006	3.322	1.419	7.777
咬饼征不伴突出	0.920	0.207	2.510	0.602	10.468
咬饼征伴突出	1.641	0.033	5.159	1.137	23.400
常数	-4.176	<0.000	0.015	—	—

下载: 导出CSV

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