甲状腺乳头状癌术前超声及临床病理特征与侵袭性的相关性
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摘要
目的探讨甲状腺乳头状癌(papillary thyroid carcinoma, PTC)术前超声及临床病理特征与侵袭性的相关性,为PTC患者手术方式选择和预后提供参考。方法回顾性分析311例PTC患者的临床特点,以病理结果为金标准,分析PTC的术前超声图像特点、临床病理特征与侵袭性表现的相关性。结果术前超声诊断颈侧区淋巴结同术后病理结果一致性较好(κ=0.554,P<0.001);术前超声诊断中央区淋巴结同术后病理结果一致性差(κ=0.006 6,P=0.863)。单因素分析显示,病灶数量、病灶大小、BRAF基因突变与甲状腺被膜侵犯相关(P<0.05);患者性别、年龄、病灶数量、病灶大小、血流、钙化、边界与淋巴结转移有相关性(P<0.05)。多因素分析显示,病灶数量、病灶大小、BRAF基因突变与被膜侵犯相关(P<0.05);患者性别、病灶大小、边界与淋巴结转移相关,差异有统计学意义(P<0.05)。结论 PTC中病灶数量、病灶大小、BRAF基因突变与被膜侵犯相关,患者性别、病灶大小、边界与淋巴结转移相关,可以为诊断提供参考。术前超声诊断PTC中央区淋巴结转移准确性差,PTC应常规清扫中央区淋巴结。
Purpose To explore the association between ultrasonographic and clinicopathological features and preoperative invasiveness of papillary thyroid carcinoma(PTC), and to provide a reference for the choice of surgical methods and prognosis in PTC patients. Methods The clinical features of 311 patients with PTC were analyzed retrospectively analysis. Association of preoperative ultrasound and clinicopathological features with invasiveness of PTC was analysed according to the pathological results as the gold standard. Results The preoperative ultrasound diagnosis of the lateral neck lymph nodes metastasis were consistent with the postoperative pathological results(κ=0.554, P<0.001), the preoperative ultrasound diagnosis of the central lymph nodes metastasis were consistent with the postoperative pathological results(κ=0.006 6, P=0.863). Univariate analysis showed the number of node lesions, size of lesions, BRAF gene mutation were assocated with thyroid capsule invasion(P<0.05), it also showed the gender, age, number of lesions, size of leisions, blood flow signal, calcification, margin were correlated with lymph node metastasis(P<0.05). Multivariate analysis showed the number of lesions, size of lesions, BRAF mutation were correlated with thyroid capsule invasion(P<0.05), it also showed the gender, size of lesions, margin were correlated with lymph node metastasis(P<0.05). Conclusion The number and size of lesions, BRAF mutation are associated with thyroid capsule invasion and the gender, size of lesions, margin are associated with lymph node metastasis which can be provide a reference for the diagnosis. The accuracy of the preoperative ultrasound diagnosis of the central lymph nodes metastasis is low, therefore the central lymph nodes of PTC patients should be dissected regularly.
Purpose To explore the association between ultrasonographic and clinicopathological features and preoperative invasiveness of papillary thyroid carcinoma(PTC), and to provide a reference for the choice of surgical methods and prognosis in PTC patients. Methods The clinical features of 311 patients with PTC were analyzed retrospectively analysis. Association of preoperative ultrasound and clinicopathological features with invasiveness of PTC was analysed according to the pathological results as the gold standard. Results The preoperative ultrasound diagnosis of the lateral neck lymph nodes metastasis were consistent with the postoperative pathological results(κ=0.554, P<0.001), the preoperative ultrasound diagnosis of the central lymph nodes metastasis were consistent with the postoperative pathological results(κ=0.006 6, P=0.863). Univariate analysis showed the number of node lesions, size of lesions, BRAF gene mutation were assocated with thyroid capsule invasion(P<0.05), it also showed the gender, age, number of lesions, size of leisions, blood flow signal, calcification, margin were correlated with lymph node metastasis(P<0.05). Multivariate analysis showed the number of lesions, size of lesions, BRAF mutation were correlated with thyroid capsule invasion(P<0.05), it also showed the gender, size of lesions, margin were correlated with lymph node metastasis(P<0.05). Conclusion The number and size of lesions, BRAF mutation are associated with thyroid capsule invasion and the gender, size of lesions, margin are associated with lymph node metastasis which can be provide a reference for the diagnosis. The accuracy of the preoperative ultrasound diagnosis of the central lymph nodes metastasis is low, therefore the central lymph nodes of PTC patients should be dissected regularly.
引文
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[8] 朱蓓琳,胡烨,李洁,等.儿童及青少年甲状腺癌的超声特点分析[J].中国超声医学杂志,2017,33(8):679-682.
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[10] Lee J H,Lee E S,Kim Y S.Clinicopathologic significance of BRAF V600E mutation in papillary carcinomas of the thyroid:a meta-analysis[J].Cancer,2007,110(1):38-40.
[11] Lee J H,Kim Y,Choi J W,Kim Y S.The association between papillary throid carcinoma and histologically proven Hashimoto’s thyroiditis:a meta-analysis[J].Eur J Endocrinol,2013,168:343-349.
[12] Shi R L,Qu N,Yang S W,et al.Tumor size interpretation for predicting cervical lymph node metastasis using a differentiated thyroid cancer risk model[J].Onco Targets Ther,2016,9:5015-5022.
[13] 邓水平,熊华花,李泉水,等.超声对甲状腺乳头状癌侧颈部淋巴结转移相关因素分析[J].中国超声医学杂志,2017,33(3):196-198.
[14] 杨海玉,刘勇.甲状腺乳头状癌的诊断与鉴别诊断[J].临床与实验病理学杂志,2017,33(6):658-663.
[15] 杨方,王学梅,张浩,等.多普勒血流动力学指标诊断甲状腺乳头状癌颈部淋巴结转移的价值[J].中国医学影像技术,2012,28(5):873-876.
[16] Knauf J A,Ma X,Smith E P,et al.Targeted expression of BRAF V600E in thyroid cells of transgenicm ice results in papillary thyroid cancers that undergo dedifferentiation[J].Cancer Res,2005,65:4238-4245.
[2] 黄丽平,俞丽云,薛恩生,等.甲状腺乳头状癌颈部淋巴结转移及转移区域相关因素分析[J].中国超声医学杂志,2015,31(3):207-210.
[3] Lu Z,Mu Y,Zhu H,et al.Clinical value of using ultrasound to assess calcification patterns in thyroid nodules[J].World J Surg,2011,35(1):122-127.
[4] Daglar-Aday A,Toptas B,Ozturk T,et al.Investigation of BRAF V600E mutation in papillary thyroid carcinoma and tumorurroundingnontumoral tissues[J].DNA Cell Biol,2013,32(1):13-18.
[5] Roti E,Rossi R,Trasforini G,et al.Clinical and histologicalcharacteristics of papillary thy roid microcarcinoma:results of a retrospective study in 243 patients[J].J Clin Endocrinol Metab,2006,91(6):2171-2178.
[6] Zaydfudim V,Feurer I D,Griffin M R,Phay J E.The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma[J].Surgery,2008,144(6):1070-1077.
[7] Sipos J A,Mazzaferri E L.The therapeutic management of differentiated thyroid cancer[J].Expert Opin Pharmacother,2008,9(15):2627-2637.
[8] 朱蓓琳,胡烨,李洁,等.儿童及青少年甲状腺癌的超声特点分析[J].中国超声医学杂志,2017,33(8):679-682.
[9] Tufano R P,Teixeira G V,Bishop J,et al.BRAF Mutation in papillary thyroid cancer and its value in tailoring initial treatment:a systematic review and meta-analysis[J].Medicine (Baltimore),2012,91(5):274-286.
[10] Lee J H,Lee E S,Kim Y S.Clinicopathologic significance of BRAF V600E mutation in papillary carcinomas of the thyroid:a meta-analysis[J].Cancer,2007,110(1):38-40.
[11] Lee J H,Kim Y,Choi J W,Kim Y S.The association between papillary throid carcinoma and histologically proven Hashimoto’s thyroiditis:a meta-analysis[J].Eur J Endocrinol,2013,168:343-349.
[12] Shi R L,Qu N,Yang S W,et al.Tumor size interpretation for predicting cervical lymph node metastasis using a differentiated thyroid cancer risk model[J].Onco Targets Ther,2016,9:5015-5022.
[13] 邓水平,熊华花,李泉水,等.超声对甲状腺乳头状癌侧颈部淋巴结转移相关因素分析[J].中国超声医学杂志,2017,33(3):196-198.
[14] 杨海玉,刘勇.甲状腺乳头状癌的诊断与鉴别诊断[J].临床与实验病理学杂志,2017,33(6):658-663.
[15] 杨方,王学梅,张浩,等.多普勒血流动力学指标诊断甲状腺乳头状癌颈部淋巴结转移的价值[J].中国医学影像技术,2012,28(5):873-876.
[16] Knauf J A,Ma X,Smith E P,et al.Targeted expression of BRAF V600E in thyroid cells of transgenicm ice results in papillary thyroid cancers that undergo dedifferentiation[J].Cancer Res,2005,65:4238-4245.