彩色多普勒超声征象联合血清Tg、TSH对甲状腺微小乳头状癌发生颈部淋巴结转移的预测价值

摘要 目的：研究彩色多普勒超声征象联合血清甲状腺球蛋白（Tg）、促甲状腺激素（TSH）对甲状腺微小乳头状癌（PTMC）发生颈部淋巴结转移的预测价值。方法：以回顾性分析法纳入研究人员共102例，均为中南大学湘雅医学院附属海口医院从2017年1月～2022年6月收治的PTMC患者。将其按照是否发生颈部淋巴结转移分成转移组35例及无转移组67例。对比两组彩色多普勒超声征象、血清Tg、TSH水平。以多因素Logistic回归分析明确PTMC发生颈部淋巴结转移的影响因素。通过受试者工作特征（ROC）曲线分析彩色多普勒超声征象以及血清Tg、TSH水平预测PTMC发生颈部淋巴结转移的效能。结果：转移组病灶形状不规则、病灶有微钙化、肿瘤大小≥0.5 cm、紧贴包膜人数占比分别为91.43%、60.00%、40.00%、48.57%，相较于无转移组的74.63%、32.84%、17.91%、23.88%均较高（均P＜0.05）；两组回声、边界、血流征象、FT3、FT4对比差异均不明显（均P＞0.05）；转移组血清Tg、TSH水平相较于无转移组更高（均P＜0.05）。经多因素Logistic回归分析可得：病灶形状不规则、病灶有微钙化以及血清Tg＞2 ng/mL、TSH＞0.5 mIU/L、肿瘤大小≥0.5 cm、紧贴包膜均是PTMC发生颈部淋巴结转移的危险因素（P＜0.05）。经ROC曲线分析发现：彩色多普勒超声征象联合血清Tg、TSH预测PTMC发生颈部淋巴结转移的曲线下面积、灵敏度以及特异度均高于上述指标单独预测。结论：彩色多普勒超声征象联合血清Tg、TSH预测PTMC发生颈部淋巴结转移的价值较高。此外，病灶形状不规则、病灶有微钙化以及血清Tg＞2 ng/mL、TSH＞0.5 mIU/L、肿瘤大小≥0.5 cm、紧贴包膜均是PTMC发生颈部淋巴结转移的危险因素。

Prediction Value of Color Doppler Ultrasound Signs Combined with Serum Tg and TSH in Cervical Lymph Node Metastasis of Thyroid Micropapillary Carcinoma

ABSTRACT Objective: To study the predictive value of color doppler ultrasound signs combined with serum thyroglobulin (Tg) and thyroid stimulating hormone (TSH) in cervical lymph node metastasis occurred of papillary thyroid microcarcinoma (PTMC). Methods: A total of 102 researchers were included in the retrospective analysis, all patients with PTMC who were admitted to Haikou Hospital Affiliated to Xiangya Medical College of Central South University from January 2017 to June 2022. They were divided into metastasis group with 35 cases and non-metastasis group with 67 cases according to whether cervical lymph node metastasis occurred. Color doppler ultrasound signs and serum Tg and TSH levels were compared between the two groups. The influencing factors of cervical lymph node metastasis of PTMC were identified by multivariate logistic regression analysis. The efficacy of color doppler ultrasound signs and serum levels of Tg and TSH in predicting cervical lymph node metastasis of PTMC was analyzed by ROC curve. Results: The percentage of lesions with irregular shape, presence of microcalcifications, tumor size ≥ 0.5 cm, and number of tightly packed envelopes was 91.43%, 60.00%, 40.00%, 48.57% in the metastasis group respectively, which was higher compared to 74.63%, 32.84%, 17.91%, 23.88% in the no metastasis group (all P<0.05); There were no significant differences in the contrast of echo, border, blood flow signs, FT3, FT4 between the two groups (all P>0.05); Serum TG and TSH levels were higher in the metastasis group compared to those in the no metastasis group (all P<0.05). Available from multiple logistic regression analysis: irregular shape of the lesions, presence of microcalcifications as well as serum TG > 2 ng/mL, TSH > 0.5 mIU/L, tumor size ≥ 0.5 cm and close adherence to the envelope were all risk factors for cervical lymph node metastasis in PTMC (P<0.05). After ROC curve analysis, we found that the area under the curve, sensitivity as well as specificity of color doppler ultrasound signs combined with serum TG and TSH in predicting the occurrence of cervical lymph node metastasis from PTMC were higher than those of the above indicators alone. Conclusion: Color doppler ultrasound signs combined with serum Tg and TSH have high value in predicting cervical lymph node metastasis of PTMC. In addition, irregular lesion shape, microcalcification, serum Tg > 2 ng/mL, TSH > 0.5 mIU/L, tumor size ≥0.5 cm, and close to the capsule are all risk factors for cervical lymph node metastasis of PTMC.