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目的探讨超声征象对甲状腺微小乳头状癌(PTMC)被膜外侵犯的预测能力。方法收集经手术治疗的PTMC患者62例,共77个结节,根据术后病理将患者分为无被膜外侵犯组(non-ETE)和有被膜外侵犯(ETE)组。回顾分析声像图特点,探讨其预测PTMC存在被膜外侵犯的能力。结果 non-ETE组43例、55(71.43%)个结节,ETE组19例、22(28.57%)个结节。结节紧邻甲状腺被膜在non-ETE组(8/55)和ETE组(19/22)比较差异有统计学意义(P=0.000),该超声征象诊断PTMC存在被膜外侵犯的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为94.00%、70.37%、85.71%、85.45%和86.36%。甲状腺被膜连续性中断或消失在non-ETE组(3/55)和ETE组(15/22)比较,差异亦有显著统计学意义(P=0.000),其诊断PTMC存在被膜外侵犯的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为83.33%、88.14%、87.01%、68.18%和94.55%。上述两项超声指标联合诊断PTMC存在被膜外侵犯的ROC曲线下面积为0.885(0.790~0.981)。结论应用超声观察结节与甲状腺被膜的关系以及被膜的完整性对判断PTMC是否存在被膜外侵犯具有重要价值。
Objective To investigate the predictive ability of ultrasound on the extravasular invasion of thyroid papillary carcinoma (PTMC). Methods Totally 77 nodules were collected from 62 patients with PTMC. The patients were divided into non-ETE group and ETE group according to postoperative pathology. The characteristics of sonography were analyzed retrospectively to investigate the ability of PTMC to predict the invasion of PTMC. Results There were 43 cases of non-ETE group, 55 (71.43%) nodules, 19 cases of ETE group and 22 (28.57%) nodules. There was a significant difference between adjacent non-ETE group (n = 8/55) and ETE group (n = 19/22) in nodules (P = 0.000). The sensitivity, specificity, The accuracy, positive predictive value and negative predictive value were 94.00%, 70.37%, 85.71%, 85.45% and 86.36% respectively. The discontinuity or disappearance of thyroid capsule continuity was also significantly different between non-ETE group (3/55) and ETE group (15/22) (P = 0.000) The specificity, accuracy, positive predictive value and negative predictive value were 83.33%, 88.14%, 87.01%, 68.18% and 94.55% respectively. The area under the receiver operating characteristic (ROC) curve for the combined diagnosis of PTMC with these two ultrasound indexes was 0.885 (0.790 ~ 0.981). Conclusion It is of great value to observe the relationship between nodules and thyroid gland capsule and the integrity of the capsule by using ultrasound to judge whether there is extracapsular invasion of PTMC.