摘要
目的:探讨常规超声中的不同指标及剪切波弹性成像(SWE)中的不同弹性模量值对甲状腺乳头状癌(PTC)患者颈部淋巴结转移的影响,并进一步探讨SWE中的不同弹性模量值的诊断效能,找出其最佳诊断界值.方法:选取2017年6月-2023年6月在青岛大学附属医院就诊的92例(122枚肿大淋巴结)患者,均经病理或FNA诊断为PTC,且均安排接受甲状腺切除手术并进行颈部淋巴结清扫,测量最大弹性值(Emax-2)、平均弹性值(Emean-2)、最小弹性值(Emin-2)和弹性标准差(SD-2),确定受试者工作特征(ROC)曲线下面积、95％置信区间,灵敏度、特异度及约登指数,并比较SWE中各弹性模量值的诊断性能.结果:122枚肿大淋巴结中,恶性淋巴结63枚(51.64％);良性淋巴结59枚(48.36％).颈部良性组与恶性组的短径、纵横比、形态、有无钙化、有无淋巴门、血流分型、Emean-2、Emax-2、Emin-2、SD-2对比,差异有统计学意义(P＜0.05);而性别、年龄、长径对比,差异无统计学意义(P＞0.05).ROC曲线分析结果显示,淋巴结中Emax-2、Emean-2、Emin-2、SD-2值的曲线下面积分别为0.868、0.861、0.824、0.776,以Emax-2的诊断效能最佳,以28.00 kPa为诊断界值时,分别对应的灵敏度为84.13％、特异度为83.64％、约登指数为0.678.结论:常规超声中淋巴结的短径、纵横比、形态、有无钙化、有无淋巴门和血流分型及SWE的4个弹性模量值均有助于对甲状腺乳头状癌颈部淋巴结是否转移进行鉴别诊断,其中Emax-2约登指数最佳,诊断效能最高.
Abstract
Objective Exploring the impact of different indicators in conventional ultrasound and different elastic modulus values in shear wave elastography(SWE)on cervical lymph node metastasis in patients with papillary thyroid carcinoma(PTC),and further exploring the diagnostic efficacy of different elastic modulus values in shear wave elastography to identify the optimal diagnostic threshold.Methods 92 patients(122 enlarged lymph nodes)who were treated at the Affiliated Hospital of Qingdao University from June 2017 to June 2023 were selected.All patients were diagnosed with PTC by pathology or fine needle aspiration(FNA),and underwent thyroidectomy and neck lymph node dissection.The maximum elasticity value(Emax-2),average elasticity value(Emean-2),minimum elasticity value(Emin-2),and standard deviation of elasticity(SD-2)were measured to determine the area under the receiver operating characteristic curve,95％confidence interval,sensitivity,specificity,and Youden index.The diagnostic performance of each elastic modulus value in SWE was compared.Results Among 122 enlarged lymph nodes,63(51.64％)were malignant lymph nodes;59 benign lymph nodes(48.36％).The short diameter,aspect ratio,morphology,presence of calcification,presence of lymph nodes,blood flow classification,Emean-2,Emax-2,Emin-2,and SD-2 were compared between the benign and malignant groups of the neck,and the differences were statistically significant(P＜0.05).However,there was no statistically significant difference in gender,age,and length(P＞0.05).The ROC curve analysis results showed that the area under the curve of Emax-2,Emean-2,Emin-2,and SD-2 values in lymph nodes were 0.868,0.861,0.824,and 0.776,respectively.Emax-2 had the best diagnostic performance,with a sensitivity of 84.13％,specificity of 83.64％,and Youden index of 0.678 corresponding to 28.00 kPa as the diagnostic threshold.Conclusion The short diameter,aspect ratio,morphology,presence or absence of calcification,presence or absence of lymph nodes and blood flow classification in routine ultrasound,as well as the four elastic modulus values of SWE,are all helpful in differential diagnosis of cervical lymph node metastasis in papillary thyroid carcinoma.Among them,Emax-2 Youden index is the best,with the highest diagnostic efficiency.
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