超声造影对甲状腺乳头状癌被膜侵犯患者的诊断价值
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摘要
目的探究超声造影对甲状腺乳头状癌被膜侵犯患者的诊断价值。方法分析2015年1月～2017年2月期间接受治疗的83例甲状腺乳头状癌患者的临床资料,患者均接受常规超声检查及超声造影检查,观察并及时记录患者病灶的个数、位置等数据,观察记录癌结节与甲状腺被膜关系。采用McNemar检验比较两种方法的诊断效能。结果83例患者中侵犯组患者为51例,存在侵犯被膜或被膜外组织的癌结节的个数为76个,占比66.67%;未侵犯组患者为32例,患者未存在侵犯被膜或被膜外组织的癌结节的个数为38个,占比33.33%。侵犯组患者的肿瘤大小为(0.87±0.49)cm,未侵犯组患者的肿瘤大小为(1.27±0.78)cm,两组数据比较差异有统计学意义(t=2.265,P<0.05)。侵犯组患者存在29例颈部淋巴结转移,占比56.86%,未侵犯组患者存在17例颈部淋巴结转移,占比53.13%,两组数据差异无统计学意义(X2=1.265,P=0.156)。常规超声检查下及超声造影检查下,随着癌结节边界与甲状腺被膜的接触面积不断增加,常规超声检查的准确率、特异度、灵敏度、阴性预测值随之下降(P<0.05);A、B组患者的曲线下面积均大于C组,数据差异具有统计学意义(P<0.05)。以癌结节与甲状腺被膜接触范围>0%判断被膜侵犯,超声造影的甲状腺乳头状癌被膜侵犯患者的R0C曲线下面积与常规超声组具有统计学意义(Z=4.321,P<0.05)。结论超声造影检查甲状腺乳头状癌被膜侵犯的效用高于常规对照组,具有重要的临床推广价值。
Objective To study the diagnostic value of contrast-enhanced ultrasound in the diagnosis of papillary thyroid carcinoma.Method The clinical data of 83 patients with papillary thyroid carcinoma who were treated in our hospital from January 2015 to February 2017 were reviewed.All subjects underwent routine ultrasound and ultrasonography.The patient's lesions were observed and recorded.The relationship between cancer nodules and thyroid capsule was analyzed.McNemar test was used to compare the diagnostic efficacy of both methods.Results Of 83 patients,there were 51 patients in infringement group and 32 patients in non-invasive group.The tumor size of infringement group and non-invasive group were 0.87± 0.49 cm and 1.27 ± 0.78cm(t= 2.265,P<0.05).There were 29 cases of cervical lymph node metastasis(56.86%).There were 17 cases of cervical lymph node metastasis in the non-invasive group(53.13%).There was no significant difference between the two groups(X2=1.265,P=0.156).Under normal ultrasound and ultrasound contrast examination,the accuracy,specificity,sensitivity and negative predictive value of conventional ultrasound were decreased with the increase of the contact area between the nodule and the thyroid capsule(P<0.05).The area under the curve of group B was greater than that of group C(P<0.05).The area under the R0 Ccurve was statistically significant(Z= 4.321,P<0.05).The area under the R0 Ccurve was statistically significant(Z= 4.321,P<0.050).The area under the R0 Ccurve of the patients with thyroid papillary carcinoma was significantly higher than that in the control group(P<0.05).Conclusion Ultrasonography under examination of thyroid papillary carcinoma capsule invasion than the conventional control group,with important clinical value.
Objective To study the diagnostic value of contrast-enhanced ultrasound in the diagnosis of papillary thyroid carcinoma.Method The clinical data of 83 patients with papillary thyroid carcinoma who were treated in our hospital from January 2015 to February 2017 were reviewed.All subjects underwent routine ultrasound and ultrasonography.The patient's lesions were observed and recorded.The relationship between cancer nodules and thyroid capsule was analyzed.McNemar test was used to compare the diagnostic efficacy of both methods.Results Of 83 patients,there were 51 patients in infringement group and 32 patients in non-invasive group.The tumor size of infringement group and non-invasive group were 0.87± 0.49 cm and 1.27 ± 0.78cm(t= 2.265,P<0.05).There were 29 cases of cervical lymph node metastasis(56.86%).There were 17 cases of cervical lymph node metastasis in the non-invasive group(53.13%).There was no significant difference between the two groups(X2=1.265,P=0.156).Under normal ultrasound and ultrasound contrast examination,the accuracy,specificity,sensitivity and negative predictive value of conventional ultrasound were decreased with the increase of the contact area between the nodule and the thyroid capsule(P<0.05).The area under the curve of group B was greater than that of group C(P<0.05).The area under the R0 Ccurve was statistically significant(Z= 4.321,P<0.05).The area under the R0 Ccurve was statistically significant(Z= 4.321,P<0.050).The area under the R0 Ccurve of the patients with thyroid papillary carcinoma was significantly higher than that in the control group(P<0.05).Conclusion Ultrasonography under examination of thyroid papillary carcinoma capsule invasion than the conventional control group,with important clinical value.
引文
[1]李晓静,蒋玲,娄萍萍,等.甲状腺癌临床及病理学特点的回顾性分析[J].中华内分泌代谢杂志,2013,29(12):1010-1014,1017.
[2]汪虹,曹钟,邵迎新,等.1239例甲状腺结节回顾性分析并文献复习[J].现代肿瘤医学,2015,21(7):921-925.
[3]洪海燕,石建华.PTEN基因与甲状腺乳头状癌相关性研究进展[J].蚌埠医学院学报,2013,38(4):502-505.
[4]徐晓琴,王旭红,荆结线,等.BRAFV600E基因突变与甲状腺乳头状癌的相关性研究进展[J].中华耳鼻咽喉头颈外科杂志,2016,51(8):630-634.
[5] Lin JD,Hsueh C,ChaoTC.Long—term follow—up of the therapeutic outcomes for papillary thyroid carcinoma with distant metastasis[J]Medicine(Baltimore),2015,94(26):1063.
[6]黄静,李燕萍,薛刚,等.血清VEGF-C、VEGF-D及VEGFR-3联合TSH检测在甲状腺乳头状癌诊断中的价值[J].南方医科大学学报,2014,32(12):1814-1817,1821.
[7]丁珂,崔秋丽,严昆,等.常规超声与超声造影判断甲状腺乳头状癌被膜侵犯的应用价值[J].中华超声影像学杂志,2017,26(3):243-248.
[8]杨春江,涂群飞,余磊涛,等.老年颈部淋巴结阴性甲状腺乳头状癌患者发生Ⅵ区淋巴转移的影响因素[J].中国老年学杂志,2015,32(13):3645-3647.
[9]王亮,吴长华,邹淑娟,等.甲状腺乳头状癌颈侧区淋巴结转移的影响因素[J].国际肿瘤学杂志,2016,43(3):207-209.
[10]张学东,陈士超,焦德,等.甲状腺乳头状癌中Slug、BRAF V600E及STIP1蛋白的表达及其与被膜侵犯和区域淋巴结转移的关系[J].肿瘤研究与临床,2017,29(2):104-107,111.
[11]周博,黄辉,徐震纲,等.未行选择性中央区淋巴结清扫的cN0甲状腺乳头状癌的远期结果[J].中国医学科学院学报,2017,39(3):383-388.
[12]蔡业丰,陈恩东,倪纯珏,等.甲状腺乳头状癌颈部中央区淋巴结转移数目对颈侧区淋巴结转移的预测价值[J].中华肿瘤杂志,2015,34(8):628-631.
[13]李逢生,韩琴芳,徐荣,等.超声造影在甲状腺乳头状癌诊断中的初步研究[J].中国超声医学杂志,2013,29(1):1-3.
[14]林新恭,吴文艺,张丽婷,等.HIC1和SIRT1的异常表达与甲状腺乳头状癌的关系研究[J].中国医科大学学报,2015,44(11):995-998.
[15]唐甜,葛伟.RTN4和TG2在甲状腺乳头状癌中的表达及临床意义[J].华中科技大学学报(医学版),2015(6):700-704.
[16]董玲玲,玉素甫,买买提,等.Src表达与甲状腺乳头状癌中央区淋巴结转移的相关性研究[J].华中科技大学学报(医学版),2017,46(1):46-49.
[17]周琦,姜珏,杜晓鹏,等.超声造影在甲状腺乳头状癌中的诊断价值[J].中国超声医学杂志,2011,27(7):595-597.
[18] Okuyama C,Kimura M,Oda M,et al.A Case of Thyroid Papillary Carcinoma:Remarkable Decrease in Multiple Lung Metastases within 40Years after a Single Administration of Radioiodine without Thyroidectomy and with Later Anaplastic Transformation[J].Case Rep Oncol,2017,10(3):928-937.
[19] Liu Z,Zeng W,Wang S,et al.A potential role for the Hippo pathway protein,YAP,in controlling proliferation,cell cycle progression,and autophagy in BCPAP and KI thyroid papillary carcinoma cells[J].Am J Transl Res,2017,9(7):3212-3223.
[20] Xu J,Chen C,Zheng C,et al.Application of a cervical low incision in the functional neck dissection of thyroid papillary carcinoma[J].Mol Clin Oncol,2016,4(4):477-482.
[21] Ma Y,Zhang X,Wang Y.Reactivity of thyroid papillary carcinoma cells to thyroid stimulating hormone-dominated endocrine therapy[J].Oncol Lett,2017,14(6):7405-7409.
[2]汪虹,曹钟,邵迎新,等.1239例甲状腺结节回顾性分析并文献复习[J].现代肿瘤医学,2015,21(7):921-925.
[3]洪海燕,石建华.PTEN基因与甲状腺乳头状癌相关性研究进展[J].蚌埠医学院学报,2013,38(4):502-505.
[4]徐晓琴,王旭红,荆结线,等.BRAFV600E基因突变与甲状腺乳头状癌的相关性研究进展[J].中华耳鼻咽喉头颈外科杂志,2016,51(8):630-634.
[5] Lin JD,Hsueh C,ChaoTC.Long—term follow—up of the therapeutic outcomes for papillary thyroid carcinoma with distant metastasis[J]Medicine(Baltimore),2015,94(26):1063.
[6]黄静,李燕萍,薛刚,等.血清VEGF-C、VEGF-D及VEGFR-3联合TSH检测在甲状腺乳头状癌诊断中的价值[J].南方医科大学学报,2014,32(12):1814-1817,1821.
[7]丁珂,崔秋丽,严昆,等.常规超声与超声造影判断甲状腺乳头状癌被膜侵犯的应用价值[J].中华超声影像学杂志,2017,26(3):243-248.
[8]杨春江,涂群飞,余磊涛,等.老年颈部淋巴结阴性甲状腺乳头状癌患者发生Ⅵ区淋巴转移的影响因素[J].中国老年学杂志,2015,32(13):3645-3647.
[9]王亮,吴长华,邹淑娟,等.甲状腺乳头状癌颈侧区淋巴结转移的影响因素[J].国际肿瘤学杂志,2016,43(3):207-209.
[10]张学东,陈士超,焦德,等.甲状腺乳头状癌中Slug、BRAF V600E及STIP1蛋白的表达及其与被膜侵犯和区域淋巴结转移的关系[J].肿瘤研究与临床,2017,29(2):104-107,111.
[11]周博,黄辉,徐震纲,等.未行选择性中央区淋巴结清扫的cN0甲状腺乳头状癌的远期结果[J].中国医学科学院学报,2017,39(3):383-388.
[12]蔡业丰,陈恩东,倪纯珏,等.甲状腺乳头状癌颈部中央区淋巴结转移数目对颈侧区淋巴结转移的预测价值[J].中华肿瘤杂志,2015,34(8):628-631.
[13]李逢生,韩琴芳,徐荣,等.超声造影在甲状腺乳头状癌诊断中的初步研究[J].中国超声医学杂志,2013,29(1):1-3.
[14]林新恭,吴文艺,张丽婷,等.HIC1和SIRT1的异常表达与甲状腺乳头状癌的关系研究[J].中国医科大学学报,2015,44(11):995-998.
[15]唐甜,葛伟.RTN4和TG2在甲状腺乳头状癌中的表达及临床意义[J].华中科技大学学报(医学版),2015(6):700-704.
[16]董玲玲,玉素甫,买买提,等.Src表达与甲状腺乳头状癌中央区淋巴结转移的相关性研究[J].华中科技大学学报(医学版),2017,46(1):46-49.
[17]周琦,姜珏,杜晓鹏,等.超声造影在甲状腺乳头状癌中的诊断价值[J].中国超声医学杂志,2011,27(7):595-597.
[18] Okuyama C,Kimura M,Oda M,et al.A Case of Thyroid Papillary Carcinoma:Remarkable Decrease in Multiple Lung Metastases within 40Years after a Single Administration of Radioiodine without Thyroidectomy and with Later Anaplastic Transformation[J].Case Rep Oncol,2017,10(3):928-937.
[19] Liu Z,Zeng W,Wang S,et al.A potential role for the Hippo pathway protein,YAP,in controlling proliferation,cell cycle progression,and autophagy in BCPAP and KI thyroid papillary carcinoma cells[J].Am J Transl Res,2017,9(7):3212-3223.
[20] Xu J,Chen C,Zheng C,et al.Application of a cervical low incision in the functional neck dissection of thyroid papillary carcinoma[J].Mol Clin Oncol,2016,4(4):477-482.
[21] Ma Y,Zhang X,Wang Y.Reactivity of thyroid papillary carcinoma cells to thyroid stimulating hormone-dominated endocrine therapy[J].Oncol Lett,2017,14(6):7405-7409.