A Risk Model for Predicting Central Lymph Node Metastasis of Papillary Thyroid Microcarcinoma Including Conventional Ultrasound and Acoustic Radiation Force Impulse Elastography.
A Risk Model for Predicting Central Lymph Node Metastasis of Papillary Thyroid Microcarcinoma Including Conventional Ultrasound and Acoustic Radiation Force Impulse Elastography.
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预测甲状腺微小乳头状癌中央淋巴结转移的风险模型，包括常规超声和声辐射力脉冲弹性成像。
DOI：
10.1097/md.0000000000002558
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发表时间：
2016-01
期刊：
影响因子：
1.6
通讯作者：
Qu S
中科院分区：
文献类型：
--
作者：
Xu JM;Xu HX;Li XL;Bo XW;Xu XH;Zhang YF;Guo LH;Liu LN;Qu S
这项前瞻性研究的目的是提出一种新的评估系统，使用包括常规超声(US)和声辐射力脉冲(ARFI)弹性成像的风险模型来预测乳头状甲状腺微癌(PTMC)患者的中心淋巴结转移(LNM)。252例PTMCs患者在术前接受超声和ARFI弹性成像检查，包括虚拟触摸组织成像(VTI)和虚拟触摸组织定量(VTQ)。采用单因素和多因素分析方法，对影响中枢性淋巴结转移的独立变量进行危险因素分析。进行了多变量分析，以建立预测模型和评级系统。在252例患者中，72例(28.6%)有中枢性LNM。多因素分析显示，少见内部血流(优势比[OR]：4.454)、多个可疑病灶累及超声(OR：5.136)、包膜受累(OR：20.632)、室间隔面积比(VAR)和腹膜后动脉(GT；1)(OR：5.621)是中心性淋巴结转移的独立危险因素。预测模型为：1.5 × (罕见内血流)+1.6 × (多发可疑病灶)+1.7 × (如果VAR和GT；1)+3.0 × (如果包膜受累)。评级体系分为5个阶段。第一阶段1.5；第二阶段1.5至3.0；第三阶段3.1至4.7；第四阶段4.8至6.3；以及第五阶段6.4至7.8。中央型淋巴结转移的危险性分别为：I期3.4%(2/59)、II期13.3%(13/98)、III期54.2%(39/72)、IV期72.2%(13/18)、V期100%(5/5)(P <； 0.001)。结果表明，罕见的内部血流、多个可疑病灶、超声受累于包膜、ARFI弹性成像上的VAR和GT；1是预测中央型LNM的危险因素。研究中开发的风险模型清楚地预测了PTMC患者发生中央性LNM的风险，因此有可能避免不必要的中央室结节清扫。
The aim of this prospective study was to propose a new rating system using a risk model including conventional ultrasound (US) and acoustic radiation force impulse (ARFI) elastography for predicting central lymph node metastasis (LNM) in patients with papillary thyroid microcarcinoma (PTMC). A total of 252 patients with PTMCs were enrolled, who were preoperatively evaluated by US and ARFI elastography including virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ). Risk factors of independent variables for central LNM were analyzed by univariate and multivariate analyses. A multivariate analysis was performed to create a predicting model and rating system. Of the 252 patients, 72 (28.6%) had central LNMs. Multivariate analysis revealed that rare internal flow (odds ratio [OR]: 4.454), multiple suspicious foci on US (OR: 5.136), capsule involvement (OR: 20.632), and VTI area ratio (VAR) > 1 (OR: 5.621) were independent risk factors for central LNM. The final predicting model was obtained and the risk score (RS) was defined as 1.5 × (if rare internal flow) + 1.6 × (if multiple suspicious foci on US) + 1.7 × (if VAR > 1) + 3.0 × (if capsule involvement). The rating system was divided into 5 stages. Stage I, <1.5; Stage II, 1.5 to 3.0; Stage III, 3.1 to 4.7; Stage IV, 4.8 to 6.3; and Stage V, 6.4 to 7.8. The risk rates of central LNM were 3.4% (2/59) in Stage I, 13.3% (13/98) in Stage II, 54.2% (39/72) in Stage III, 72.2% (13/18) in Stage IV, and 100% (5/5) in Stage V (P < 0.001). The results indicated that rare internal flow, multiple suspicious foci, capsule involvement on US, and VAR > 1 on ARFI elastography are the risk factors for predicting central LNM. The risk model developed in the study clearly predicts the risk of central LNM in patients with PTMC and thus has a potential to avoid unnecessary central compartment node dissection.