摘要
目的探讨双能量CT(DECT)征象与定量参数联合生化指标预测甲状腺乳头状癌(PTC)颈淋巴结转移的可行性。方法回顾性分析2020年6月至2023年3月中国科学技术大学附属第一医院西区(安徽省肿瘤医院)收治的115例经病理诊断为PTC患者的术前资料。按病理结果分为颈淋巴结转移组(n=65)和非转移组(n=50)。分析两组患者DECT形态学特征、定量参数[碘浓度(IC)、标准化碘浓度(NIC)、能谱曲线斜率(λ_(HU))],比较术前常规检测血清甲状腺球蛋白及其抗体浓度,通过logsitic回归分析PTC颈部淋巴结转移的独立危险因素,构建基于独立危险因素的联合模型,绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)评估各模型预测效力。结果两组患者年龄、原发灶最大直径、原发灶数目、包膜侵犯、IC、NIC及λ_(HU),差异有统计学意义(P<0.05)。经多因素logistic回归分析确定年龄(OR=0.396,95%CI:0.206~0.763,P=0.006)为保护因素,包膜侵犯(OR=3.499,95%CI:1.812~6.757,P<0.001)、IC(OR=6.948,95%CI:1.191~40.533,P=0.031)及NIC(OR=3.836,95%CI:1.360~10.817,P=0.011)是PTC颈部淋巴结转移的独立危险因素。ROC曲线结果表明,年龄、包膜侵犯、IC、NIC及联合模型预测PTC颈淋巴结转移均具有统计学意义(P<0.05),且联合模型诊断效力最优,AUC为0.928,95%CI:0.882~0.974,灵敏度为93.8%,特异度为80.0%。结论PTC原发灶的DECT征象及其定量参数能够在术前有效预测颈淋巴结转移,联合模型可进一步提高预测效力,有助于临床治疗方案的制定。
Objective To investigate the feasibility of dual energy CT(DECT)signs and quantitative parameters combined with biochemical indicators in predicting cervical lymph node metastasis of papillary thyroid cancer(PTC).Methods The preoperative data of 115 patients pathologically diagnosed with PTC who were admitted to the West District of the First Affiliated Hospital of University of Science and Technology of China(Anhui Cancer Hospital)from June 2020 to March 2023 were selected.According to pathology,they were divided into the cervical lymph node metastasis group(n=65)and the non-metastasis group(n=50).The morphological characteristics,quantitative parameters(IC,NIC,λ_(HU))of DECT in the two groups of patients and the preoperative routine detection of serum thyroglobulin and its antibodies were analyzed.The independent risk factors of cervical lymph node metastasis of PTC were analyzed by logsitic regression.A combined model based on independent risk factors was constructed,and the receiver operating characteristic(ROC)curve was drawn.The predictive efficacy of each model was evaluated by the area under the curve(AUC).Results There were statistically significant differences in age,maximum diameter of primary lesion,number of primary lesions,capsule invasion,IC,NIC andλ_(HU) between the two groups(P<0.05).Multiple logistic regression analysis,age(OR=0.396,95%CI:0.206~0.763,P=0.006)was identified as a protective factor,while capsule invasion(OR=3.499,95%CI:1.812~6.757,P<0.001),IC(OR=6.948,95%CI:1.191~40.533,P=0.031),and NIC(OR=3.836,95%CI:1.360~10.817,P=0.011)were identified as independent risk factors for PTC cervical lymph node metastasisThe results of the ROC curve indicated that age,capsule invasion,IC,NIC and the combined model all had statistical significance in predicting cervical lymph node metastasis of PTC and the combined model had the best diagnostic efficacy,with an AUC of 0.928,95%CI of 0.882~0.974,a sensitivity of 93.8%and a specificity of 80%.Conclusion The DECT signs and quantitative parameters of PTC primary lesions can effectively predict cervical lymph node metastasis preoperatively.The combined model can further improve the prediction efficiency and help to formulate clinical treatment plans.
作者
赵培
魏龙宇
吴瑶媛
董江宁
ZHAO Pei;WEI Longyu;WU Yaoyuan;DONG Jiangning(Department of Ultrasound,People's Hospital of Dangshan County,Suzhou,234000,China;Graduate School of Bengbu Medical University,Bengbu,233000,China;West Imaging Department,the First Affiliated Hospital of China University of Science and Technology,Hefei,230031,China)
出处
《安徽医学》
2025年第12期1492-1497,共6页
Anhui Medical Journal
基金
医学人工智能联合基金(编号:MAI2023Q032)
安徽省临床医学重点专科建设资助项目(编号:2019sjlczdzk)。
关键词
双能量CT
甲状腺乳头状癌
颈淋巴结转移
Dual-energy CT
Papillary thyroid cancer
Cervical lymph node metastasis
