中国普外基础与临床杂志

中国普外基础与临床杂志

甲状腺乳头状癌的超声术前风险评估探讨

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目的 探讨超声术前评估甲状腺乳头状癌复发风险分层对临床诊疗的价值。 方法 回顾性分析 2017 年 1~12 月期间在四川大学华西医院进行手术切除且术后病理学检查证实为甲状腺乳头状癌的 400 例患者(400 个病灶)的临床资料,评价超声复发风险评级与术后临床复发风险分级的一致性及相关性。 结果 400 个病灶中,病灶直径为(12.8±8.5)mm,其中≤10 mm 的病灶 214 个,10~40 mm 的病灶 178 个,>40 mm 的病灶 8 个。发生淋巴结转移 242 例,出现被膜侵犯 309 例。临床复发风险分级:低危 225 个,中危 147 个,高危 28 个。超声复发风险分级:低危 93 个,中危 126 个,高危 15 个。术后复发危险分层和术前超声复发风险分层的一致性中等(κ=0.414,P<0.05)。此外,超声检查与临床对于淋巴结转移的一致性较差(κ=0.291,P<0.05),对于被膜侵犯判断的一致性中等(κ=0.402,P<0.05)。 结论 甲状腺超声术前评估复发风险分级,侧重于个体化的术前评估,评估内容更加详细和细致,有助于后续治疗及早期筛查复发风险。

Objective To evaluate the value of preoperative risk assessment of papillary thyroid carcinoma with ultrasound for clinic diagnosis and treatment. Methods The data of 400 patients with papillary thyroid carcinoma received operative treatment in 2017 were retrospectively analyzed. Recorded and analyzed the ultrasonic risk assessment and postoperative grading of clinic risk assessment, to evaluate coherence and correlation between them. Results There were 400 lesions with an average size of (12.8±8.5) mm. Among 400 lesions, diameter of 214 lesions less than 10 mm, diameter of 178 lesions were between 10 mm and 40 mm, and diameter of 8 lesions were larger than 40 mm. A total of 242 cases had lymph node metastasis and 309 cases had capsule invasion. Clinical and ultrasoud risk assessment was performed on 400 lesions. There were 225 lesions with low risk of clinical risk stratification vs. 93 lesions with low ultrasonic risk, 147 lesions with intermediate risk of clinical risk stratification vs. 126 lesions with intermediate ultrasonic risk, and 28 lesions with high risk of clinical risk stratification vs. 15 lesions with high ultrasonic risk. The consistency of postoperative recurrence risk stratification and preoperative ultrasound recurrence risk stratification was moderate (κ=0.414, P<0.05). In addition, the consistency between ultrasound examination and clinical lymph node metastasis was poor (κ=0.291, P<0.05), and the consistency of invasion of the capsule was moderate (κ=0.402, P<0.05). Conclusion Preoperative evaluation of recurrence risk grading before thyroid ultrasound, focusing on individualized preoperative assessment, the assessment is more detailed and detailed, and is helpful for follow-up treatment and early screening for recurrence risk.

关键词: 甲状腺乳头状癌; 超声诊断; 术前诊断; 风险分层

Key words: papillary thyroid carcinoma; ultrasonic diagnosis; preoperative diagnosis; risk grading

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