超声联合血清TSH、FGF-19检测在甲状腺癌术前N分期中的应用价值
Application value of ultrasound combined with serum TSH and FGF-19 in preoperative N staging of thyroid cancer
富威东 1程起2
作者信息
- 1. 311202 浙江杭州,杭州师范大学附属萧山医院超声医学科
- 2. 深圳市宝安区人民医院超声科
- 折叠
摘要
目的 探讨超声联合血清促甲状腺激素(TSH)、成纤维细胞生长因子19(FGF-19)检测在甲状腺癌术前N分期中的应用价值.方法 回顾分析2021年10 月至2022年10 月在深圳市宝安区人民医院实施甲状腺切除手术的100 例患者临床资料,根据术后淋巴结节活检病理结果将其分为pN0期、pN1a期和pN1b期,采用Kappa检验分析超声评估N分期和病理评估的一致性;采用单因素及多因素分析甲状腺癌术前N分期的影响因素,并绘制受试者工作特征(ROC)曲线分析超声联合血清TSH、FGF-19检测对甲状腺癌术前N分期诊断的价值.结果 术前超声评估N分期与病理N分期呈中等一致性(Kappa=0.52,P＜0.05).单因素分析提示超声结节数量、纵横比、形态、边缘情况及血清TSH、FGF-19水平与术前N分期相关(χ2 分别=15.76、4.83、29.19、28.93,t分别=8.17、12.21,P均＜0.05),多因素分析显示超声征象(结节数量、纵横比、形态、边缘情况)及血清TSH、FGF-19水平均为甲状腺癌术前N分期的独立影响因素(OR分别=1.04、1.30、1.05、1.29、1.18、1.62,P均＜0.05).ROC分析显示超声联合血清TSH、FGF-19检测诊断术前N分期的曲线下面积(AUC)为0.87,灵敏度为81.08%,特异度为93.65%,其中AUC、特异度均明显高于单一诊断(Z分别=5.64、8.24、4.52,χ2分别=7.50、13.18、10.79,P均＜0.05).结论 术前超声联合血清TSH、FGF-19对甲状腺癌术前N分期的诊断具有一定价值,三者联合可提高诊断特异度,为淋巴结转移的早期诊断提供可靠信息.
Abstract
Objective To investigate the application value of ultrasound combined with serum thyroid stimulating hor-mone(TSH)and fibroblast growth factor-19(FGF-19)in preoperative N staging of thyroid cancer.Methods The clini-cal data of 100 patients who underwent thyroidectomy in Shenzhen Bao'an People's Hospital from October 2021 to Octo-ber 2022 were analyzed retrospectively.The lesions were divided into pN0 stage,pN1a stage and pN1b stage according to postoperative pathological results.Kappa test was conducted to analyze the consistency of N staging using ultrasound and pathological results.The risk factors of N staging of thyroid cancer were analyzed through univariate analysis and mul-tivariate analysis.The value of ultrasound combined with serum TSH and FGF-19 in preoperative N staging of thyroid cancer was analyzed using the receiver operating characteristic(ROC)curve.Results There was moderate consistency between preoperative ultrasound evaluation of N staging and pathological N staging(Kappa=0.52,P＜0.05).Univariate analysis found that the number,aspect ratio,morphology and edge of nodules,serum TSH and FGF-19 were correlated with preoperative N staging(χ2=15.76,4.83,29.19,28.93,t=8.17,12.21,P＜0.05).Multivariate analysis found that ul-trasonic signs(number,aspect ratio,morphology and edge of nodules)and serum TSH and FGF-19 levels were inde-pendent influencing factors for preoperative N stag-ing of thyroid cancer(OR=1.04,1.30,1.05,1.29,1.18,1.62,P＜0.05).ROC analysis showed that the area under the curve(AUC)of ultrasound com-bined with serum TSH and FGF-19 for preoperative N staging was 0.87,with sensitivity of 81.08%and specificity of 93.65%.The AUC and specificity were significantly higher than those of single diagnosis(Z=5.64,8.24,4.52,χ2=7.50,13.18,10.79,P＜0.05).Conclusion Ultrasound combined with serum TSH and FGF-19 is helpful for preoperative N staging of thyroid cancer.The combination of the three can improve diagnostic specificity and provide reliable information for early diagnosis of lymph node metastasis.
关键词
超声/促甲状腺激素/成纤维细胞生长因子-19/甲状腺癌/N分期/淋巴结转移Key words
ultrasound/thyroid stimulating hormone/fibroblast growth faetor-19/thyroid cancer/N stage/lymph node metastasis引用本文复制引用
出版年
2024
NETL
NSTL
万方数据