文章摘要

超声造影定量参数与甲状腺乳头状癌组织中微血管密度、颈部淋巴结转移的关系

作者: 1李 秀芹
1 河南省中医药研究院附属医院影像科,郑州 450000
通讯: 李 秀芹 Email: rmour9047@163.com
DOI: 10.3978/j.issn.2095-6959.2020.01.009

摘要

目的:探究超声造影(contrast-enhanced ultrasound,CEUS)定量参数与甲状腺乳头状癌(papillary thyroid carcinoma,PTC)组织中微血管密度(microvessel density,MVD)、颈部淋巴结转移的关系。方法:抽取2016年9月至2019年1月河南省中医药研究院附属医院手术病理确诊的75例PTC患者,根据颈部淋巴结病理结果分为转移组(24例)、未转移组(51例)。术前均行CEUS检查,获得PTC结节内及周围正常甲状腺组织相关血流灌注参数,取PTC结节、正常组织病理标本经免疫组织化学染色获取MVD,并进行统计学分析。结果:PTC结节达峰时间(time peak,TP)、平均渡越时间(mean transit time,MTT)显著高于周围正常组织,峰值强度(peak intensity,PI)及曲线下面积(area under the curve,AUC)显著低于周围正常组织(P<0.05),且MVD显著低于周围正常组织(P<0.05)。Spearman秩相关性分析显示PTC结节的造影参数TP,MTT与MVD无明显相关性(P>0.05),而PI,AUC与MVD明显正相关(P<0.05)。与未转移组相比,转移组PI,AUC,MVD显著增高(P<0.05),TP,MTT未见明显差异(P>0.05)。PI,AUC预测颈部淋巴结转移的受试者工作特征(receiver operating characteristic,ROC)的AUC分别为0.864,0.877,确定临界值后PI和AUC预测颈部淋巴结转移的敏感度均≥75.0%,特异度均为88.2%。多因素logistic同归分析显示病灶数目、肿瘤大小、PI和AUC为预测颈部淋巴结转移的独立危险因素(P<0.05)。结论:CEUS血流灌注参数PI、AUC与PTC组织中MVD显著相关,并对颈部淋巴结转移有一定预测价值,可作为PTC术前评估的无创性方法。
关键词: 超声造影;血流灌注参数;甲状腺乳头状癌;微血管密度;淋巴结转移

Relationship between quantitative parameters of contrast-enhanced ultrasound and microvessel density, cervical lymph nodes metastasis in papillary thyroid carcinoma tissues

Authors: 1LI Xiuqin
1 Imaging Department, Affiliated Hospital of Henan Academy of Chinese Medicine, Zhengzhou 450000, China

CorrespondingAuthor:LI Xiuqin Email: rmour9047@163.com

Abstract

Objective: To investigate the relationship between quantitative parameters of contrast-enhanced ultrasound (CEUS) and microvessel density (MVD), cervical lymph node metastasis in papillary thyroid carcinoma (PTC) tissues. Methods: Seventy-five PTC patients confirmed by surgical pathology in Affiliated Hospital of Henan Academy of Chinese Medicine during the period from September 2016 to January 2019 were enrolled. According to pathological results of cervical lymph nodes, they were divided into a metastasis group (24 cases) and a non-metastasis group (51 cases). CEUS was performed on them before operation. The related blood flow perfusion parameters of PTC nodules and surrounding normal thyroid tissues were obtained. PTC nodules and normal histopathological specimens were collected to obtain MVD by immunohistochemical staining. And statistical analysis was performed. Results: The time peak (TP) and mean transit time (MTT) of PTC nodules were significantly higher than those of surrounding normal tissues, while peak intensity (PI) and area under the curve (AUC) were significantly lower than those of surrounding normal tissues (P<0.05). And MVD was significantly lower than that of surrounding normal tissues (P<0.05). Spearman rank correlation analysis showed CEUS parameter of PTC nodules such as TP and MTT were not significantly correlated with MVD (P>0.05), while PI and AUC were significantly positively correlated with MVD (P<0.05). Compared with the non-metastasis group, PI and AUC were significantly increased in the metastasis group (P<0.05). There was no significant difference in TP or MTT (P>0.05), while MVD was significantly increased (P<0.05). The receiver operating characteristic (ROC) curve AUC of PI and AUC for predicting cervical lymph node metastasis were 0.864 and 0.877, respectively. After determining critical value, the sensitivities of PI and AUC for predicting cervical lymph node metastasis were all not less than 75.0%, and the specificities were all 88.2%. Multivariate logistic regression analysis showed that the number of lesions, tumor size, PI and AUC were independent risk factors for predicting cervical lymph node metastasis (P<0.05). Conclusion: The CEUS blood flow perfusion parameters PI and AUC are significantly correlated with MVD in PTC tissues, which are of certain predictive value for cervical lymph node metastasis. They can be used as a noninvasive method for preoperative PTC evaluation.
Keywords: contrast-enhanced ultrasound; blood flow perfusion parameter; papillary thyroid carcinoma; microvessel density; lymph node metastasis