国际肿瘤学杂志

国际肿瘤学杂志››2022,Vol. 49››Issue (10): 581-585.doi:10.3760/cma.j.cn371439-20220414-00115

• 论著 •上一篇下一篇

静脉期CT值预测甲状腺乳头状癌中央组淋巴结转移的临床研究

李劲浩, 王桂东(), 李雪菲, 刘子琳, 孟凯龙

  1. 河北省邯郸市第一医院CT室，邯郸 056002
  • 收稿日期:2022-04-14修回日期:2022-09-05出版日期:2022-10-08发布日期:2022-12-01
  • 通讯作者:王桂东 E-mail:wgd2007@126.com

Clinical study of venous phase CT value in predicting central group lymph node metastasis of papillary thyroid carcinoma

Li Jinhao, Wang Guidong(), Li Xuefei, Liu Zilin, Meng Kailong

  1. CT Room， First Hospital of Handan City， Hebei Province， Handan 056002， China
  • Received:2022-04-14Revised:2022-09-05Online:2022-10-08Published:2022-12-01
  • Contact:Wang Guidong E-mail:wgd2007@126.com

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摘要：

目的探讨原发病灶影像学特征联合静脉期CT值用于甲状腺乳头状癌（PTC）患者中央组淋巴结转移的预测价值。方法回顾性分析2017年1月—2020年6月于河北省邯郸市第一人民医院170例行中央组淋巴结清扫的PTC患者的临床资料，根据中央组淋巴结是否伴转移分组，其中伴中央组淋巴结转移组89例，未伴中央组淋巴结转移组81例。分析原发病灶不同时期CT值和影像学特征，绘制受试者工作特征（ROC）曲线评估原发病灶影像学特征联合静脉期CT值预测中央组淋巴结转移效能。结果伴和未伴中央组淋巴结转移患者平扫期CT值、动脉期CT值、净增CT值及标准化CT值比较差异均无统计学意义（均P>0.05）；伴中央组淋巴结转移患者静脉期CT值、净增CT值及标准化CT值分别为（113.84±22.95）HU、（59.05±12.10）HU、0.72±0.14，均高于未伴中央组淋巴结转移患者的（103.99±17.67）HU、（51.29±14.45）HU、0.59±0.10（t=3.26，P<0.001；t=3.81，P<0.001；t=3.67，P<0.001）。ROC曲线分析显示，静脉期CT值、净增CT值及标准化CT值截断值分别为115.78 HU、62.37 HU、0.75时诊断PTC患者中央组淋巴结转移的曲线下面积分别为0.75、0.70、0.76。伴和未伴中央组淋巴结转移患者原发灶直径、甲状腺包膜接触范围比较差异有统计学意义（Z=-2.34，P=0.019；Z=-2.08，P=0.037）；有无钙化、原发病灶位置差异均无统计学意义（均P>0.05）；病灶直径>2 cm（87.73%）和包膜接触范围≥1/2（92.17%）预测中央组淋巴结转移的特异性最高。原发病灶影像学特征联合静脉期标准化CT值预测中央组淋巴结转移结果与病理组织学诊断结果具有良好一致性，Kappa=0.475，敏感性和特异性分别为73.12%、82.75%。结论原发病灶影像学特征联合静脉期CT值在PTC患者中央组LN中央组淋巴结转移预测方面具有良好临床价值，其中原发病灶直径>2 cm、包膜接触范围≥1/2及静脉期标准化CT值>0.75者更易出现中央组淋巴结转移。

关键词:甲状腺肿瘤,淋巴转移,体层摄影术，螺旋计算机

Abstract:

ObjectiveTo investigate the clinical value of imaging features of primary lesions combined with venous phase CT value in predicting central group lymph node （LN） metastasis in patients with papillary thyroid carcinoma （PTC）.MethodsClinical data of 170 PTC patients who underwent central group LN dissection in the First People's Hospital of Handan City of Hebei Province from January 2017 to June 2020 were retrospectively analyzed. All patients were divided into different groups according to whether central group LN metastasis or not， and there were 89 patients with central group LN metastasis and 81 patients without central group LN metastasis. The CT value and imaging features of primary lesions in different periods were analyzed， and the imaging features of primary lesions combined with venous phase CT values to predict the central group LN metastasis were evaluated by the receiver operating characteristic （ROC） curve.ResultsThere were no statistically significant differences in CT value in plain scan phase and CT value， net increased CT value， standardized CT value in arterial phase between patients with and without central group LN metastasis （allP>0.05）. The CT value， net increased CT value and standardized CT value in venous phase of patients with central group LN metastasis were （113.84±22.95） HU， （59.05±12.10） HU and 0.72±0.14 respectively， which were significantly higher than those of patients without central group LN metastasis [（103.99±17.67） HU， （51.29±14.45） HU and 0.59±0.10]（t=3.26，P<0.001；t=3.81，P<0.001；t=3.67，P<0.001）. ROC curve analysis showed that the area under the curve for diagnosing central group LN metastasis of PTC patients was 0.75， 0.70 and 0.76 when the cut-off values of CT value， net increased CT value and standardized CT value in venous phase were 115.78 HU， 62.37 HU and 0.75 respectively. There were statistically significant differences in the diameter of primary focus and the contact area of thyroid capsule between patients with and without central group LN metastasis （Z=-2.34，P=0.019；Z=-2.08，P=0.037）. There were no statistically significant differences between calcification and primary lesion location （bothP>0.05）. Lesion diameter >2 cm （87.73%） and capsule contact range ≥1/2 （92.17%） had the highest specificity in predicting central group LN metastasis. The imaging features of primary lesion combined with standardized CT value in venous phase was in good agreement with histopathological diagnosis results in predicting central group LN metastasis （Kappa=0.475）， and the sensitivity and specificity were 73.12% and 82.75% respectively.ConclusionThe imaging features of the primary lesion combined with CT value in venous phase have a good clinical value in predicting central group LN metastasis in PTC patients. Patients with primary lesion diameter >2 cm， capsule contact range ≥1/2 and the standardized CT value in venous phase >0.75 are more likely to have central group LN metastasis.

Key words:Thyroid neoplasms,Lymphatic metastasis,Tomography， spiral computed