基于ACR TI-RADS分类对甲状腺乳头状癌淋巴结转移风险模型的预测
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摘要
【目的】应用美国放射学会(ACR)甲状腺影像报告及数据系统(ACR TI-RADS 2017)对甲状腺乳头状癌患者转移风险进行评估,提高超声对甲状腺转移癌检出率。【方法】回顾分析经病理确诊的甲状腺乳头状癌163例,根据术后N分期分为转移与非转移2组,对照临床和病理特征,对ACR TI-RADS评分与甲状腺乳头状癌患者发生淋巴结转移的关系进行单因素和多因素分析。【结果】发生淋巴结转移患者TI-RADS评分为12.0(10.0,14.0),高于未发生转移的患者(P=0.003),多因素logistic回归结果显示超声发现淋巴结及TI-RADS评分高是甲状腺癌患者发生淋巴结转移的危险因素(对于TI-RADS评分,OR=1.15,95%CI=1.03-1.28,P=0.02;对于超声发生现淋巴结,OR=3.20,95%CI=1.41-7.27,P=0.01)。按单病灶或多病灶进行分层分析显示对于单病灶人群,超声发现淋巴结和TI-RADS评分高会增加甲状腺癌发生淋巴结转移的风险;而对于多病灶人群,未发现存在统计学联系。【结论】ACR TI-RADS评分结合病灶位置及数量、超声检出淋巴结等因素有利于提高甲状腺癌淋巴结转移的检出率,为临床进一步治疗提供决策。
【Objective】To evaluate the risk of lymph node metastasis of papillary thyroid cancer(PTC) under the guideline of thyroid imaging report and data system(TI-RADS) published by American College of Radiology(ACR),aiming at improving the detection rate of thyroid metastatic carcinoma by combining correlative factors and ACR score【Methods】A total of 163 patients diagnosed as papillary thyroid cancer by surgery and pathological indication were ineluded in the study. The recruitment took place in a hospital in Shenzhen and all selected participants were divided into lymph node metastasis group and lymph node negative group respectively. Then, the information about clinical and pathological manifestation of the patients were collected before carrying multiple unconditional logistic regression test to obtain odds ratios( OR) and 95% confidence intervals(CI) between ACR TI-RADS and the risk of lymph node metastasis of PTC.【Results】The score of TI-RADS was 12.0( 10.0,14.0) among the patients with lymph node metastasis, higher than those without metastasis(P < 0.003). Multiple factor logistic regression illustrated that both ultrasonography detected lymph node and TI-RADS score were risk factors for lymph node metastasis in patients with thyroid carcinoma(for TIRADS scores, OR=1.15, 95% CI 1.03-1.28, P = 0.02; for lymph nodes with ultrasound, OR = 3.20. 95%CI=1.41-7.27, P = 0.01). For single lesion populations, an increased occurrence of lymph node metastasis carcinoma had been proved by stratified analysis when lymph node metastasis detected by ultrasonography, together with high score of TIRADS. However there was no significance in the statistical correlation in terms of multiple lesions.【Conclusion】ACR score combined with related factors can improve thyroid metastatic carcinoma detection rate and provide therapeutic strategy for further treatment.
【Objective】To evaluate the risk of lymph node metastasis of papillary thyroid cancer(PTC) under the guideline of thyroid imaging report and data system(TI-RADS) published by American College of Radiology(ACR),aiming at improving the detection rate of thyroid metastatic carcinoma by combining correlative factors and ACR score【Methods】A total of 163 patients diagnosed as papillary thyroid cancer by surgery and pathological indication were ineluded in the study. The recruitment took place in a hospital in Shenzhen and all selected participants were divided into lymph node metastasis group and lymph node negative group respectively. Then, the information about clinical and pathological manifestation of the patients were collected before carrying multiple unconditional logistic regression test to obtain odds ratios( OR) and 95% confidence intervals(CI) between ACR TI-RADS and the risk of lymph node metastasis of PTC.【Results】The score of TI-RADS was 12.0( 10.0,14.0) among the patients with lymph node metastasis, higher than those without metastasis(P < 0.003). Multiple factor logistic regression illustrated that both ultrasonography detected lymph node and TI-RADS score were risk factors for lymph node metastasis in patients with thyroid carcinoma(for TIRADS scores, OR=1.15, 95% CI 1.03-1.28, P = 0.02; for lymph nodes with ultrasound, OR = 3.20. 95%CI=1.41-7.27, P = 0.01). For single lesion populations, an increased occurrence of lymph node metastasis carcinoma had been proved by stratified analysis when lymph node metastasis detected by ultrasonography, together with high score of TIRADS. However there was no significance in the statistical correlation in terms of multiple lesions.【Conclusion】ACR score combined with related factors can improve thyroid metastatic carcinoma detection rate and provide therapeutic strategy for further treatment.
引文
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[13]刘烺飚,韩承新,舒清明,等.甲状腺结节钙化与甲状腺癌的关系[J].武警医学,2017(2):150-151,156.Liu LB,Han CX,Shu QM,et al.Relationship between thyroid nodule calcification and thyroid cancer[J].Med J Chin PAP,2017,2(28):150-156
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[15]Lee YJ,Kim DW,Park HK,et al.Pre-operative ultrasound diagnosis of nodal metastasis in papillary thyroid carcinoma patients according to nodal compartment[J].Ultrasound Med Biol,2015,41(5):1294-1300.
[16]Na DK,Choi YJ,Choi SH,et al.Evaluation of cervical lymph node metastasis in thyroid cancer patients using real-time CT-navigated ultrasonography:preliminary study[J].Ultrasonography,2015,34(l):39-44.
[17]Hoang JK,Middleton WD,Farjat AE,et al.Reduction in thyroid nodule biopsies and improved accuracy with American College of Radiology Thyroid Imaging Reporting and Data System[J].Radiology,2018,287(1):185-193.
[18]Delfim RLC,Veiga LCGD,Vidal APA,et al.Likelihood of malignancy in thyroid nodules according to a proposed Thyroid Imaging Reporting and Data System(TI-RADS)classification merging suspicious and benign ultrasound features[J].Arch Endocrinol Metab,2017,61(3):211-221.
[19]冯红芳,陈创,孙圣荣,等.1585例甲状腺癌的临床病理特点及总结分析[J].中国肿瘤临床,2015(02):77-81.Feng HF,Chen C,Sun SR,et al.The analysis of clinicopathologic characteristics of thyroid cancer:a retrospective study of 1585 cases[J].Chin J Clin Oncol,2015,2(42):77-81.
[20]Kwak JY,Han KH,Yoon JH,et al.Thyroid imaging reporting and data system for U S features of nodules:a step in astablishing better stratification of cancer risk[J].Radiology,2011,260(3):892-899.
[21]陈晓康,陈少华,吕国荣.超声TI-RADS分类对甲状腺结节的诊断价值[J].中国超声医学杂志,2012(12):1066-1068.Chen XK,Chen SH,LüGR.The applicational value of TI-RADS ultrasonographic stratification in diagnosing thyroid nodules[J].Chin J Ultrasound Med,2012,12(28):1066-1068.
[2]Guth S,Theune U,Aberle J,et al.Very high prevalence of thyroid nodules detected by high frequency(13 MHz)ultrasound examination[J].Eur J Clin Invest,2009,39(8):699-706.
[3]Park JY,Lee HJ,Jang HW,et al.A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma[J].Thyroid,2009,19(11):1257-1264.
[4]Jun P,Chow LC,Jeffrey RB.The sonographic features of papillary thyroid carcinomas:pictorial essay[J].Ultrasound Q,2005,21(1):39-45.
[5]Tessler FN,Middleton WD,Grant EG,et al.ACRThyroid Imaging,Reporting and Data System(TI-RADS):White Paper of the ACR TI-RADS:Committee[J].J Am Coll Radiol,2017,14(5):587-595.
[6]Grant EG,Tessler FN,HoangG JK,et al.Thyroid ultrasound reporting lexicon:white paper of the ACR thyroid imaging,reporting and data system(TI-RADS)committee[J].J Am Coll Radiol,2015,12(12 Pt A):1272-1279.
[7]Hoang JK,Langer JE,Middleton WD,et al.Managing incidental thyroid nodules detected on imaging:White Paper of the ACR Incidental Thyroid Findings Committee[J].J Am Coll Radiol,2015,12(2):143-150.
[8]孙庆贺,张磊,杨进宝,等.2073例甲状腺乳头状癌淋巴结转移危险因素的分析[J].中华外科杂志,2017,55(8):592-298.Sun QH,Zhang L,Yang JB,et al.Related factors analysis for lymph node metastasis in papillary thyroid carcinoma:a series of 2073 patients[J].Chin JSurg,2017,8(55):592-598.
[9]姚瑶,张园,夏雷.667例甲状腺癌的临床病理分析及治疗[J].中国肿瘤外科杂志,2013(02):76-78.Yao Y,Zhang Y,Xia L.Analysis of the clinicopathological features and therapy of 667 cases of thyroid cancer[J].Chin J Surg,2013,2(5):76-78.
[10]Yin X,Liu C,Guo Y,et al.Influence of tumor extent on central lymph node metastasis in solitary papillary thyroid microcarcinomas:a retrospective study of 1092 patients[J].World J Surg Oncol,2017,15(1):133-140.
[11]Huang XP,Ye TT,Zhang L,et al.Sonographic features of papillary thyroid microcarcinoma predicting high-volume central neck lymph node metastasis[J].Surg Oncol,2018,27(2):172-176.?
[12]Xu JM,Xu HX,Li XL,et al.A risk model for predicting central lymph node metastasis of papillary thyroid microcarcinoma including conventional ultrasound and acoustic radiation force impulse elastography[J].Medicine(Baltimore),2016,95(3):e2558.
[13]刘烺飚,韩承新,舒清明,等.甲状腺结节钙化与甲状腺癌的关系[J].武警医学,2017(2):150-151,156.Liu LB,Han CX,Shu QM,et al.Relationship between thyroid nodule calcification and thyroid cancer[J].Med J Chin PAP,2017,2(28):150-156
[14]马步云,Parajuly SS,彭玉兰,等.甲状腺影像报告和数据系统在超声检查甲状腺结节中的应用[J].中国普外基础与临床杂志,2011,8(18):898-901.Ma BY,Parajuly SS,Peng YL,et al.The value of Sonography in thyroid imaging reporting and data system for thyroid nodule[J].Chin J Bases Clin General Surg,2011,8(18):898-901.
[15]Lee YJ,Kim DW,Park HK,et al.Pre-operative ultrasound diagnosis of nodal metastasis in papillary thyroid carcinoma patients according to nodal compartment[J].Ultrasound Med Biol,2015,41(5):1294-1300.
[16]Na DK,Choi YJ,Choi SH,et al.Evaluation of cervical lymph node metastasis in thyroid cancer patients using real-time CT-navigated ultrasonography:preliminary study[J].Ultrasonography,2015,34(l):39-44.
[17]Hoang JK,Middleton WD,Farjat AE,et al.Reduction in thyroid nodule biopsies and improved accuracy with American College of Radiology Thyroid Imaging Reporting and Data System[J].Radiology,2018,287(1):185-193.
[18]Delfim RLC,Veiga LCGD,Vidal APA,et al.Likelihood of malignancy in thyroid nodules according to a proposed Thyroid Imaging Reporting and Data System(TI-RADS)classification merging suspicious and benign ultrasound features[J].Arch Endocrinol Metab,2017,61(3):211-221.
[19]冯红芳,陈创,孙圣荣,等.1585例甲状腺癌的临床病理特点及总结分析[J].中国肿瘤临床,2015(02):77-81.Feng HF,Chen C,Sun SR,et al.The analysis of clinicopathologic characteristics of thyroid cancer:a retrospective study of 1585 cases[J].Chin J Clin Oncol,2015,2(42):77-81.
[20]Kwak JY,Han KH,Yoon JH,et al.Thyroid imaging reporting and data system for U S features of nodules:a step in astablishing better stratification of cancer risk[J].Radiology,2011,260(3):892-899.
[21]陈晓康,陈少华,吕国荣.超声TI-RADS分类对甲状腺结节的诊断价值[J].中国超声医学杂志,2012(12):1066-1068.Chen XK,Chen SH,LüGR.The applicational value of TI-RADS ultrasonographic stratification in diagnosing thyroid nodules[J].Chin J Ultrasound Med,2012,12(28):1066-1068.