超声特征联合剪切波弹性成像预测接触包膜甲状腺乳头状癌患者中央区淋巴结转移的价值OA
Value of ultrasound features combined with shear wave elastography in predicting central lymph node metastasis in patients with capsule-contacting papillary thyroid carcinoma
目的 探讨超声特征联合剪切波弹性成像(SWE)对接触包膜的甲状腺乳头状癌(PTC)患者发生中央区淋巴结转移(CLNM)的预测价值.方法 回顾性收集2022年1月至2024年12月浙江中医药大学附属杭州市中医院术前超声图像显示接触甲状腺包膜并术后病理检查证实为单灶PTC的患者109例,其中CLNM 44例,无CLNM 65例,术前均进行超声特征及SWE检查及评估,包括结节最大径、微钙化、边缘、结节接触包膜角度、结节接触包膜程度、结节凸出包膜轮廓、SWE杨氏模量最大值(Emax)、最小值(Emin)、平均值(Emean);采用多因素logistic回归分析筛选出CLNM独立危险因素,建立联合预测模型,并绘制ROC曲线分析其对CLNM的预测效能.结果 单因素分析显示,CLNM组和无CLNM组患者的结节最大径、微钙化、结节接触包膜程度、结节凸出包膜轮廓及SWE Emax比较差异均有统计学意义(均P＜0.05);ROC曲线分析得出,SWE Emax最佳截断值为63.1 kPa,结节最大径的最佳截断值为7.3 mm.多因素logistic回归分析显示接触包膜程度≥25％、结节最大径＞7.3 mm、Emax＞63.1 kPa均是结节接触包膜PTC发生CLNM的独立危险因素(均P＜0.05),其联合预测模型的AUC为0.853,灵敏度为0.818,特异度为0.800,高于各指标单独预测效能.结论 超声特征联合SWE对结节接触包膜的PTC发生CLNM有较好的预测价值,术前仔细评估相关特征,为临床个体化治疗方案的选择提供参考.
Objective To investigate the predictive value of ultrasound features combined with shear wave elastography(SWE)for central lymph node metastasis(CLNM)in capsule-contacting papillary thyroid carcinoma(PTC).Methods A retrospective collection was performed on 109 patients with single-focal PTC confirmed by postoperative pathology at Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University from January 2022 to December 2024.All patients underwent preoperative ultrasound showing thyroid capsule contact.Among them,44 had CLNM,while 65 did not.All patients underwent preoperative examinations and evaluations of ultrasound characteristics and SWE,including maximum nodule diameter,microcalcification,margin,capsule contact angle,capsule contact extent,protrusion of the capsule contour,and SWE parameters[maximum Young's modulus(Emax),minimum Young's modulus(Emin),mean Young's modulus(Emean)].Multivariate logistic regression was used to screen independent risk factors for CLNM,a combined prediction model was established,and ROC curve was plotted to analyze its predictive efficacy for CLNM.Results Univariate analysis showed statistically significant differences in maximum nodule diameter,microcalcification,protrusion of the capsule contour,and SWE Emax between the CLNM group and non-CLNM group(all P＜0.05).ROC curve analysis showed that the optimal cutoff value of SWE Emax was 63.1 kPa and that of maximum PTC diameter was 7.3 mm.Multivariate logistic regression revealed that capsule contact extent ≥25％,maximum PTC diameter＞7.3 mm,and Emax＞63.1 kPa were independent risk factors for CLNM in capsule-contacting PTC(all P＜0.05).The combined prediction model achieved AUC of 0.853,a sensitivity of 0.818,and a specificity of 0.800,which were higher than the predictive efficacy of each indicator alone.Conclusion Ultrasound features combined with SWE have good predictive value for CLNM in capsule-contacting PTC.Careful preoperative evaluation of these features can provide a reference for the selection of individualized clinical treatment strategies.
郭东;黄石飞;姚烨菲;张正贤;王露;单悦
310007 浙江中医药大学附属杭州市中医院超声科310007 浙江中医药大学附属杭州市中医院普外科310007 浙江中医药大学附属杭州市中医院超声科310007 浙江中医药大学附属杭州市中医院超声科310007 浙江中医药大学附属杭州市中医院超声科310007 浙江中医药大学附属杭州市中医院超声科
甲状腺乳头状癌接触包膜剪切波弹性成像中央区淋巴结转移
Papillary thyroid carcinomaCapsule-contactingShear wave elastographyCentral lymph node metastasis
《浙江医学》 2026 (5)
481-485,后插3,6
浙江省医药卫生科技计划项目(2023KY984)
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