摘要
目的探讨超声联合甲状腺球蛋白(Tg)检测在甲状腺癌术前N分期中的价值。方法回顾性分析2018年8月至2020年10月在中国科学院大学附属肿瘤医院(浙江省肿瘤医院)经手术及病理证实的1 138例甲状腺癌患者的临床资料, 将其分为pN0期、pN1a期和pN1b期, 采用Kappa一致性检验分析超声评估N分期与病理N分期的一致性。以病理结果为金标准, 分析部分术前血清标志物与淋巴结转移的相关性。利用ROC曲线比较单纯超声、Tg及超声联合Tg对判断淋巴结转移的价值。结果术前超声评估N分期与病理N分期一致性中等(Kappa=0.459, P<0.01);pN0期与pN1期(pN1a期+pN1b期)血清标志物中游离三碘甲状腺原氨酸(fT3)、抗甲状腺过氧化物酶抗体(TPOAb)、Tg差异有统计学意义(均P<0.05);有差异的指标中, 仅Tg对淋巴结转移的影响差异有统计学意义(P<0.01);Tg预测甲状腺癌淋巴结转移的ROC曲线下面积(AUC)为0.679, 最佳临界值为25.245 μg/L, 单纯超声、超声联合Tg的AUC分别为0.699、0.775, 联合诊断方法优于单纯超声。结论术前超声与血清Tg对评估甲状腺癌N分期具有一定价值, 二者联合对淋巴结转移的诊断价值高于单纯超声。
Objective To investigate the value of ultrasound combined with thyroglobulin(Tg)in preoperative N staging of thyroid carcinoma.Methods The clinical data of 1138 patients with thyroid carcinoma in the Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital)from August 2018 to October 2020,who confirmed by surgery and pathology were analyzed retrospectively.The 1138 cases were divided into pN0,pN1a,and pN1b stages.Kappa consistency test was used to analyze the consistency of ultrasound evaluation of N staging and pathological N staging.Pathology result was taken as the gold standard to analyze the correlation between some preoperative serum markers and lymph node metastasis.The ROC curve was used to compare the diagnostic value of ultrasound,Tg,and ultrasound combined with Tg for lymph node metastasis.Results The preoperative ultrasound assessment of N staging was moderately consistent with pathology(Kappa=0.459,P<0.01).Between pN0 and pN1(pN1a+pN1b)stages,the differences in free triiodothyronine(fT3),anti-thyroid peroxidase antibody(TPOAb)and Tg were statistically significant(all P<0.05).Among the different indicators,only Tg had significant effect on lymph node metastasis(P<0.01).The area under the ROC curve(AUC)of Tg in predicting lymph node metastasis of thyroid cancer was 0.679,while the best cut-off value for Tg was 25.245μg/L.The AUC of only ultrasound and ultrasound combined with Tg were 0.699 and 0.775,respectively.Therefore,combined diagnosis method was better than ultrasound only.Conclusions Preoperative ultrasound and thyroglobulin has a specific value in evaluating the N staging of thyroid carcinoma.The combination of the two is more valuable in the diagnosis of lymph node metastasis than ultrasound only.
作者
王卉
赵珊珊
姚劲草
彭婵娟
徐栋
Wang Hui;Zhao Shanshan;Yao Jincao;Peng Chanjuan;Xu Dong(Zhejiang Chinese Medical University,Hangzhou 310053,China;Department of Ultrasound,Shaoxing People′s Hospital,Shaoxing 312000,China;Department of Ultrasound,the Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital),Institute of Basic Medicine and Cancer(IBMC),Chinese Academy of Sciences,Key Laboratory of Head&Neck Cancer Translational Research of Zhejiang Province,Hangzhou 310022,China;Department of Ultrasound,the Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital),Institute of Basic Medicine and Cancer(IBMC),Chinese Academy of Sciences,Key Laboratory of Head&Neck Cancer Translational Research of Zhejiang Province,Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology,Shanghai Tenth People′s Hospital,Tongji University School of Medicine,Hangzhou 310022,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2022年第2期122-128,共7页
Chinese Journal of Ultrasonography
基金
国家自然科学基金(82071946)
浙江省自然科学基金(LSD19H180001, LZY21F030001)
浙江省卫生健康科技计划面上项目(2021KY099)。
关键词
超声检查
甲状腺球蛋白
肿瘤分期
淋巴结转移
Ultrasonography
Thyroglobulin
Neoplasm staging
Lymph node metastasis
