CAJ | 학술논문

目的：探讨甲状腺乳头状癌（PTC）与颈部淋巴结转移相关的超声征象，为判断PTC有无颈部淋巴结转移提供参考。方法回顾性分析2011-2013年哈尔滨医科大学附属第一医院经手术后病理证实的170例PTC患者的超声征象。其中59例伴颈部淋巴结转移，111例无颈部淋巴结转移。采用操作者工作特性（ROC）曲线分析阻力指数（RI）、收缩期峰值血流速度（PSV）判断PTC有无颈部淋巴结转移的最佳诊断界限值。采用χ2和秩和检验比较PTC伴颈部淋巴结转移患者与无颈部淋巴结转移患者原发灶超声征象差异。采用Logistic回归分析PTC伴颈部淋巴结转移的相关因素。结果 ROC曲线分析显示，RI、PSV判断PTC有无颈部淋巴结转移的最佳诊断界限值分别为0.735、13.95 cm/s。与PTC无颈部淋巴结转移患者比较，PTC伴颈部淋巴结转移患者原发灶直径、是否有晕环、是否累及甲状腺上极、有无微钙化、血供分级、RI及PSV差异均有统计学意义；而原发灶回声、边界是否清晰、纵横比差异均无统计学意义。多因素Logistic回归分析显示，PTC原发灶直径及PSV这2个因素是PTC伴颈部淋巴结转移的相关独立因素。结论 PTC原发灶的一些超声征象与PTC有无颈部淋巴结转移有密切的相关性，可为术前PTC患者颈部淋巴结有无转移的诊断提供有价值的信息。
목적：탐토갑상선유두상암（PTC）여경부림파결전이상관적초성정상，위판단PTC유무경부림파결전이제공삼고。방법회고성분석2011-2013년합이빈의과대학부속제일의원경수술후병리증실적170례PTC환자적초성정상。기중59례반경부림파결전이，111례무경부림파결전이。채용조작자공작특성（ROC）곡선분석조력지수（RI）、수축기봉치혈류속도（PSV）판단PTC유무경부림파결전이적최가진단계한치。채용χ2화질화검험비교PTC반경부림파결전이환자여무경부림파결전이환자원발조초성정상차이。채용Logistic회귀분석PTC반경부림파결전이적상관인소。결과 ROC곡선분석현시，RI、PSV판단PTC유무경부림파결전이적최가진단계한치분별위0.735、13.95 cm/s。여PTC무경부림파결전이환자비교，PTC반경부림파결전이환자원발조직경、시부유훈배、시부루급갑상선상겁、유무미개화、혈공분급、RI급PSV차이균유통계학의의；이원발조회성、변계시부청석、종횡비차이균무통계학의의。다인소Logistic회귀분석현시，PTC원발조직경급PSV저2개인소시PTC반경부림파결전이적상관독립인소。결론 PTC원발조적일사초성정상여PTC유무경부림파결전이유밀절적상관성，가위술전PTC환자경부림파결유무전이적진단제공유개치적신식。
Objective To study the sonographic features of papillary thyroid carcinoma (PTC) associated with cervical lymph nodes metastasis for early diagnosis and prediction of the invaded cervical lymph nodes. Methods The sonographic features of 170 patients with pathologically confirmed PTC in First Afifliated Hospital of Harbin Medical University between 2011 and 2013 were retrospectively reviewed. There were 59 cases with neck lymph nodes metastases and 111 cases without neck lymph nodes metastases. Receiver operating characteristic (ROC) curve was aaplied to analyze the cut-off values of resistance index (RI) and peak systolic velocity (PSV) for judging the presence or absence of cercical lymph node metastasis. The Chi-square test and rank sum test were used to compare the different sonographic features between each group. The Logistic regression analysis was used to obtain the relevant factors of PTCs with cervical lymph node metastasis. Results ROC curve analysis showed that the cut-off values of RI and PSV were 0.735,13.95 cm/s. The primary tumor diameter, the existence of halo, the involvement of thyroid upper pole, the microcalciifcation, the blood suply classiifcation and the RI, PSV were statistically signiifcantly different between PTCs with and without cervical lymph node metastasis, whereas no statistical signiifcance was detected between the primary tumor echo pattern, boundary and the longitudinal/transveral ratio between the metastatic and nonmetastatic group. Logistic regression analysis showed that the PTC primary tumor diameter and PSV were independent factors coorelated with cervical lymph node metastasis. Conclusion Some sonographic features of PTC are closely correlated with lymph nodes metastasis, which are valuable in predicting the cervical lymph nodes metastasis in patients with PTC pre-operatively.