PTMC甲状腺外侵犯诊断中高分辨率超声的诊断价值研究
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摘要
目的探讨甲状腺微小乳头状癌(PTMC)甲状腺外侵犯诊断中高分辨率超声的诊断价值。方法甲状腺肿瘤患者259例,结节直径≤1 cm,以病理检查为金标准,比较常规二维超声诊断PTMC的敏感度和特异度,并应用高分辨率超声检测患者包块与甲状腺被膜关系,并将有甲状腺被膜接触的患者根据其接触程度分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级,分析结节与被膜接触程度和甲状腺外侵犯的相关性。结果经手术或病理证实92例患者为PTMC,共108个结节;167例患者为甲状腺良性病变,共179个结节。以病理检查为金标准,超声诊断PTMC的敏感度为91.67%,特异度为94.41%,准确度为93.38%。当PTMC与相邻的甲状腺被膜有密切接触时,其对甲状腺外侵犯率明显增加,差异有统计学意义(P<0.05),分别以Ⅰ、Ⅱ、Ⅲ、Ⅳ级被膜接触程度为高分辨率超声诊断PTMC甲状腺外侵犯的标准,其ROC曲线下面积分别为0.744(0.649,0.840)、0.806(0.717,0.895)、0.624(0.514,0.733)、0.578(0.466,0.689),Ⅱ级与甲状腺被膜接触≥20%作为诊断标准的价值最大。结论高分辨率超声诊断PTMC甲状腺外侵犯的敏感度和特异度高,且以结节与甲状腺被膜接触≥20%作为诊断标准的应用价值最高,值得在临床PTMC甲状腺外侵诊断中应用。
Objective To evaluate the diagnostic value of high-resolution ultrasonography in the diagnosis of papillary thyroid microcarcinoma( PTMC) with extrathyroidal invasion. Methods A total of 259 patients who had thyroid tumor with nodular diameter ≤1 cm were enrolled in this study. Taking pathological examination as gold standard,the sensitivity and specificity of conventional two-dimensional ultrasonography in diagnosis of PTCM were compared, and high-resolution ultrasonography examnation results were used to analyze the relationship between the masses and the thyroid capsule. In addition,the patients with thyroid tumors were divided into grades Ⅰ、Ⅱ、Ⅲ,and Ⅳ according to the contact extent with fibrous capsule of thyroid gland. The correlation between contact extent with fibrous capsule of thyroid gland and extrathyroidal invasion was analyzed. Results A total of 92 patients were surgically or pathologically confirmed as PTMC( 108 nodules),and 167 patients were confirmed as benign thyroid lesions( 179 nodules). Taking pathological examination as gold standard,the sensitivity,specificity and accuracy of ultrasonography in diagnosis of PTMC was 91. 67%,94. 41% and 93. 38%,respectively. When the PTMC was in close contact with the adjacent thyroid capsule,the extrathyroidal invasion rate was significantly increased( P < 0. 05). The grade Ⅰ、Ⅱ、Ⅲ,and Ⅳ contact extent with the capsule were used as diagnostic criteria for PTMC with extrathyroidal invasion,the area under ROC curve was 0. 744( 0. 649,0. 840),0. 806( 0. 717,0. 895),0. 624( 0. 514,0. 733),and 0. 578( 0. 466,0. 689),respectively. Therefore,the area of contact with thyroid gland ≥ 20%( Grade Ⅱ) had the greatest value as a diagnostic criterion. Conclusion The sensitivity and specificity of high-resolution ultrasonography in diagnosis of PTMC with extrathyroidal invasion are higher,and the contact area with fibrous capsule of thyroid gland ≥ 20% is of the highest application value,therefore,which is worthy of application in clinical diagnosis of PTMC with extrathyroidal invasion.
Objective To evaluate the diagnostic value of high-resolution ultrasonography in the diagnosis of papillary thyroid microcarcinoma( PTMC) with extrathyroidal invasion. Methods A total of 259 patients who had thyroid tumor with nodular diameter ≤1 cm were enrolled in this study. Taking pathological examination as gold standard,the sensitivity and specificity of conventional two-dimensional ultrasonography in diagnosis of PTCM were compared, and high-resolution ultrasonography examnation results were used to analyze the relationship between the masses and the thyroid capsule. In addition,the patients with thyroid tumors were divided into grades Ⅰ、Ⅱ、Ⅲ,and Ⅳ according to the contact extent with fibrous capsule of thyroid gland. The correlation between contact extent with fibrous capsule of thyroid gland and extrathyroidal invasion was analyzed. Results A total of 92 patients were surgically or pathologically confirmed as PTMC( 108 nodules),and 167 patients were confirmed as benign thyroid lesions( 179 nodules). Taking pathological examination as gold standard,the sensitivity,specificity and accuracy of ultrasonography in diagnosis of PTMC was 91. 67%,94. 41% and 93. 38%,respectively. When the PTMC was in close contact with the adjacent thyroid capsule,the extrathyroidal invasion rate was significantly increased( P < 0. 05). The grade Ⅰ、Ⅱ、Ⅲ,and Ⅳ contact extent with the capsule were used as diagnostic criteria for PTMC with extrathyroidal invasion,the area under ROC curve was 0. 744( 0. 649,0. 840),0. 806( 0. 717,0. 895),0. 624( 0. 514,0. 733),and 0. 578( 0. 466,0. 689),respectively. Therefore,the area of contact with thyroid gland ≥ 20%( Grade Ⅱ) had the greatest value as a diagnostic criterion. Conclusion The sensitivity and specificity of high-resolution ultrasonography in diagnosis of PTMC with extrathyroidal invasion are higher,and the contact area with fibrous capsule of thyroid gland ≥ 20% is of the highest application value,therefore,which is worthy of application in clinical diagnosis of PTMC with extrathyroidal invasion.
引文
1 Kim DW.Long-term follow-up ultrasonography after lobectomy in papillary thyroid microcarcinoma patients:A single-center study.Endocrine Research,2016,41:1-3.
2 Acharya UR,Chowriappa P,Fujita H,et al.Thyroid lesion classification in 242 patient population using Gabor transform features from high resolution ultrasound images.Knowledge-Based Systems,2016,107:235-245.
3 朱栩杭,陈丽羽,葛明华.甲状腺微小乳头状癌的超声诊断进展.中国肿瘤,2015,24:471-475.
4 Yoon JH,Lee HS,Kim EK,et al.Short-term follow-up US leads to higher false-positive results without detection of structural recurrences in PTMC.Medicine,2016,95:e2435.
5 刘颖,林僖,李安华,等.甲状腺乳头状微小癌与非微小癌超声特征的对比研究.中国超声医学杂志,2016,32:769-772.
6 Wei Z,Shan J,Zhan W,et al.Ultrasound-guided percutaneous laser ablation of unifocal T1N0M0 papillary thyroid microcarcinoma:Preliminary results.European Radiology,2016:1-7.
7 Gao Y,Qu N,Zhang L,et al.Preoperative ultrasonography and serum thyroid-stimulating hormone on predicting central lymph node metastasis in thyroid nodules as or suspicious for papillary thyroid microcarcinoma.Tumor Biology,2015,37:7453-7459.
8 王云梅,李逢生,刘曙光,等.超声造影与弹性成像对甲状腺微小乳头状癌的诊断价值.陕西医学杂志,2015,24:576-579.
9 Kim SC,Kim JH,Choi SH,et al.Off-site evaluation of three-dimensional ultrasound for the diagnosis of thyroid nodules:comparison with twodimensional ultrasound.European Radiology,2016,26:1-8.
10 Lee YC,Eun YG,Sohn YM,et al.Predictive factors for occult contralateral carcinoma in patients with unilateral papillary thyroid microcarcinoma by preoperative ultrasonographic and pathological features.World Journal of Surgery,2015,39:1736-41.
11 姜月茗,许幼峰,陈立斌,等.实时超声造影技术在甲状腺微小乳头状癌诊断中的应用研究.中华超声影像学杂志,2015,24:882-885.
12 Hirsch D,Robenshtok E,Bachar G,et al.The implementation of the bethesda system for reporting thyroid cytopathology improves malignancy detection despite lower rate of thyroidectomy in indeterminate nodules.World Journal of Surgery,2015,39:1959-1965.
13 武元元,王军,管玲,等.TI-RADS分级联合超声弹性成像诊断甲状腺微小乳头状癌价值研究.中国实用外科杂志,2016,36:552-555.
14 Kim SK,Lee JH,Woo JW,et al.Prediction table and nomogram as tools for diagnosis of papillary thyroid carcinoma:combined analysis of ultrasonography,fine-needle aspiration biopsy,and BRAF V600E mutation.Medicine,2015,94:e760.
15 Wu Q,Wang Y,Li Y,et al.Diagnostic value of contrast-enhanced ultrasound in solid thyroid nodules with and without enhancement.Endocrine,2016,53:480-488.
16 孙春桂,姚志勇,吴云爽,等.高频彩超在甲状腺微小乳头状癌诊断中的临床应用价值.现代中西医结合杂志,2016,25:3404-3406.
17 Ertas B,Kaya H,Kurtulmus N,et al.Intraoperative ultrasonography is useful in surgical management of neck metastases in differentiated thyroid cancers.Endocrine,2015,48:248-253.
18 Elsayed NM,Elkhatib YA.Diagnostic criteria and accuracy of malignant thyroid nodules by ultrasonography and ultrasound elastography with pathologic correlation.Ultrasonic Imaging,2015,97:67-71.
19 周瑾瑾,王春光,孙文奎,等.高分辨率超声对甲状腺微小乳头状癌甲状腺外侵犯的诊断价值研究.医学影像学杂志,2016,26:2208-2211.
20 Lee SJ,Lim GY,Kim JY,et al.Diagnostic performance of thyroid ultrasonography screening in pediatric patients with a hypothyroid,hyperthyroid or euthyroid goiter.Pediatric Radiology,2016,46:1-8.
2 Acharya UR,Chowriappa P,Fujita H,et al.Thyroid lesion classification in 242 patient population using Gabor transform features from high resolution ultrasound images.Knowledge-Based Systems,2016,107:235-245.
3 朱栩杭,陈丽羽,葛明华.甲状腺微小乳头状癌的超声诊断进展.中国肿瘤,2015,24:471-475.
4 Yoon JH,Lee HS,Kim EK,et al.Short-term follow-up US leads to higher false-positive results without detection of structural recurrences in PTMC.Medicine,2016,95:e2435.
5 刘颖,林僖,李安华,等.甲状腺乳头状微小癌与非微小癌超声特征的对比研究.中国超声医学杂志,2016,32:769-772.
6 Wei Z,Shan J,Zhan W,et al.Ultrasound-guided percutaneous laser ablation of unifocal T1N0M0 papillary thyroid microcarcinoma:Preliminary results.European Radiology,2016:1-7.
7 Gao Y,Qu N,Zhang L,et al.Preoperative ultrasonography and serum thyroid-stimulating hormone on predicting central lymph node metastasis in thyroid nodules as or suspicious for papillary thyroid microcarcinoma.Tumor Biology,2015,37:7453-7459.
8 王云梅,李逢生,刘曙光,等.超声造影与弹性成像对甲状腺微小乳头状癌的诊断价值.陕西医学杂志,2015,24:576-579.
9 Kim SC,Kim JH,Choi SH,et al.Off-site evaluation of three-dimensional ultrasound for the diagnosis of thyroid nodules:comparison with twodimensional ultrasound.European Radiology,2016,26:1-8.
10 Lee YC,Eun YG,Sohn YM,et al.Predictive factors for occult contralateral carcinoma in patients with unilateral papillary thyroid microcarcinoma by preoperative ultrasonographic and pathological features.World Journal of Surgery,2015,39:1736-41.
11 姜月茗,许幼峰,陈立斌,等.实时超声造影技术在甲状腺微小乳头状癌诊断中的应用研究.中华超声影像学杂志,2015,24:882-885.
12 Hirsch D,Robenshtok E,Bachar G,et al.The implementation of the bethesda system for reporting thyroid cytopathology improves malignancy detection despite lower rate of thyroidectomy in indeterminate nodules.World Journal of Surgery,2015,39:1959-1965.
13 武元元,王军,管玲,等.TI-RADS分级联合超声弹性成像诊断甲状腺微小乳头状癌价值研究.中国实用外科杂志,2016,36:552-555.
14 Kim SK,Lee JH,Woo JW,et al.Prediction table and nomogram as tools for diagnosis of papillary thyroid carcinoma:combined analysis of ultrasonography,fine-needle aspiration biopsy,and BRAF V600E mutation.Medicine,2015,94:e760.
15 Wu Q,Wang Y,Li Y,et al.Diagnostic value of contrast-enhanced ultrasound in solid thyroid nodules with and without enhancement.Endocrine,2016,53:480-488.
16 孙春桂,姚志勇,吴云爽,等.高频彩超在甲状腺微小乳头状癌诊断中的临床应用价值.现代中西医结合杂志,2016,25:3404-3406.
17 Ertas B,Kaya H,Kurtulmus N,et al.Intraoperative ultrasonography is useful in surgical management of neck metastases in differentiated thyroid cancers.Endocrine,2015,48:248-253.
18 Elsayed NM,Elkhatib YA.Diagnostic criteria and accuracy of malignant thyroid nodules by ultrasonography and ultrasound elastography with pathologic correlation.Ultrasonic Imaging,2015,97:67-71.
19 周瑾瑾,王春光,孙文奎,等.高分辨率超声对甲状腺微小乳头状癌甲状腺外侵犯的诊断价值研究.医学影像学杂志,2016,26:2208-2211.
20 Lee SJ,Lim GY,Kim JY,et al.Diagnostic performance of thyroid ultrasonography screening in pediatric patients with a hypothyroid,hyperthyroid or euthyroid goiter.Pediatric Radiology,2016,46:1-8.
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