剪切波弹性成像预测甲状腺乳头状癌颈部淋巴结转移的价值
摘要
目的评价剪切波弹性成像(SWE)的弹性指数预测乳头状甲状腺癌(PTC)颈部淋巴结转移的价值。方法选取了179例PTC患者行SWE检测,获取病灶的弹性指数(E_(mean)、E_(max)、E_(mix)、E_(ratio-p)、E_(ratio-m)),所有病变均以病理检查结果为金标准,对SWE鉴别颈部淋巴结转移及甲状腺外扩散(ETE)的准确性进行评价。结果中央区淋巴结转移(CLN)与无CLN的E_(mean)分别为104.8±58.4和78.6±48.2(P<0.001),颈侧区淋巴结转移(LLN)与无LLN的E_(mean)分别为127.6±60.4和86.4±45.9(P<0.001),甲状腺外扩散(ETE)与无ETE的E_(mean)分别为102.0±48.3和78.6±32.5(P<0.001)。CLN组和无CLN组的E_(mean)的临界点为121 kPa,其敏感度为75.3%、特异度为81.3%,曲线下面积为0.826;LLN组和无LLN组的E_(mean)的临界点为134 kPa,其敏感度为68.3%、特异度为76.3%,曲线下面积为0.797。结论 SWE在预测甲状腺乳头状癌颈部淋巴结转移及ETE中具有重要临床价值。
引文
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[13] Park AY, Kim JA, Son EJ, et al. Shear-Wave Elastography for Papillary Thyroid Carcinoma can Improve Prediction of Cervical Lymph Node Metastasis[J]. Ann Surg Oncol, 2016, 23(5):722-729.
[14] Tan Y, Tajik A, Chen J,et al. Matrix softness regulates plasticity of tumourrepopulating cells via H3K9 demethylation and Sox2 expression[J]. Nat Commun,2014,5: 4619.
[15] Lu P, Weaver VM, Werb Z. The extracellular matrix: a dynamic niche in cancer progression[J]. Cell Biol,2012,196(4):395-406.
[16] Bierie B, Chung CH, Parker JS, et al. Abrogation of TGF-beta signaling enhances chemokine production and correlates with prognosis in human breast cancer[J]. J Clin Invest,2009,119(6):1571-1582.
[17] Alexander NR, Branch KM, Parekh A,et al. Extracellular matrix rigidity promotes invadopodia activity[J]. Curr Biol,2008,18(17): 1295-1299.
[2] Choi JS, Kim J, Kwak JY, et al. Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT[J]. AJR Am J Roentgenol, 2009, 193(3):871-878.
[3] Ji SC, Chung WY, Jin YK, et al. Staging of papillary thyroid carcinoma with ultrasonography: performance in a large series[J]. Ann Surg Oncol, 2011, 18(13):3572-3578.
[4] Park AY, Son EJ, Han K, et al. Shear wave elastography of thyroid nodules for the prediction of malignancy in a large scale study[J]. Eur J Radiol, 2015, 84(3):407-412.
[5] Tubiana M, Schlumberger M, Rougier P, et al. Long-term results and prognostic factors in patients with differentiated thyroid carcinoma[J]. Cancer, 1985, 55(4):794-804.
[6] 石岚, 黄韬. 甲状腺乳头状癌淋巴结转移规律的研究[J]. 中华普通外科杂志, 2007, 22(7):524-526.
[7] Lundgren CI, Hall P, Dickman PW, et al. Clinically significant prognostic factors for differentiated thyroid carcinoma[J]. Cancer, 2006, 106(3):524-531.
[8] Lundgren CI, Hall P, Dickman PW, et al. Influence of surgical and postoperative treatment on survival in differentiated thyroid cancer.[J]. Br J Surg, 2007, 94(5):571-577.
[9] Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone[J]. Ann Surg, 2007, 245(4):604-610.
[10] Cavicchi O, Piccin O, Caliceti U, et al. Transient hypoparathyroidism following thyroidectomy: a prospective study and multivariate analysis of 604 consecutive patients[J]. Otolaryngol Head Neck Surg, 2007, 137(4):654-658.
[11] Hong YR, Yan CX, Mo GQ, et al. Conventional US, elastography, and contrast enhanced US features of papillary thyroid microcarcinoma predict central compartment lymph node metastases[J]. Sci Rep, 2015, 5:7748.
[12] Park YJ, Kim JA, Son EJ, et al. Quantitative shear wave elastography as a prognostic implication of papillary thyroid carcinoma (PTC): elasticity index can predict extrathyroidal extension (ETE)[J]. Ann Surg Oncol, 2013, 20(8):2765-2771.
[13] Park AY, Kim JA, Son EJ, et al. Shear-Wave Elastography for Papillary Thyroid Carcinoma can Improve Prediction of Cervical Lymph Node Metastasis[J]. Ann Surg Oncol, 2016, 23(5):722-729.
[14] Tan Y, Tajik A, Chen J,et al. Matrix softness regulates plasticity of tumourrepopulating cells via H3K9 demethylation and Sox2 expression[J]. Nat Commun,2014,5: 4619.
[15] Lu P, Weaver VM, Werb Z. The extracellular matrix: a dynamic niche in cancer progression[J]. Cell Biol,2012,196(4):395-406.
[16] Bierie B, Chung CH, Parker JS, et al. Abrogation of TGF-beta signaling enhances chemokine production and correlates with prognosis in human breast cancer[J]. J Clin Invest,2009,119(6):1571-1582.
[17] Alexander NR, Branch KM, Parekh A,et al. Extracellular matrix rigidity promotes invadopodia activity[J]. Curr Biol,2008,18(17): 1295-1299.