| 摘要: |
| 目 的 ：探讨基于常规超声及超声造影特征构建的列线图模型术前预测甲状腺乳头状癌（PTC）颈部淋巴结转移的价值。
方 法 ：回顾性分析华东师范大学附属芜湖医院及北京大学第三医院共216例经病理确诊为PTC患者甲状腺原发灶的常规超声及超声造影特征，以术后病理是否存在颈部淋巴结转移作为金标准。根据有无淋巴结转移分为转移组54例（LNM组）、非转移组162例（NLNM组）。采用单因素及多因素Logistic回归分析筛选预测颈部淋巴结转移的独立危险因素。基于独立危险因素构建联合预测模型，以列线图的形式展示。
结 果：单因素Logistic回归分析结果显示性别（为男性）、多灶性、最大径（≥1cm）、微钙化、血流、强化、增强模式、浅方被膜、穿刺手感共9个指标两组间比较差异有统计学意义（P＜0.05）；多因素Logistic回归分析确定性别（为男性）、多灶性、最大径（≥1cm）、血流、强化、增强模式、浅方被膜为独立危险因素，列线图预测模型的曲线下面积（AUC）为0.822，与其他单独指标比较差异均具有统计学意义（均P＜0.05），Hosmer-Lemeshow检验显示模型拟合较好（2=8.298，P=0.405），校准曲线显示预测值与实测值一致性较高，临床决策曲线（DCA）分析表明列线图模型在所有模型中临床适用价值最大。5折交叉验证的AUC分别为0.871（95%CI：0.781-0.961）、0.900（95%CI：0.840-0.959）、0.707（95%CI：0.581-0.834）、0.678（95%CI：0.556-0.800）、0.762（95%CI：0.654-0.870），平均AUC为0.784。
结 论：基于常规超声、超声造影特征构建的列线图模型术前能够有效预测PTC颈部淋巴结转移。 |
| 关键词: 超声造影 甲状腺乳头状癌 颈部淋巴结转移 列线图 |
| DOI： |
| 投稿时间：2022-11-22修订日期：2023-02-12 |
| 基金项目: |
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| Preoperative prediction of cervical lymph node metastasis of papillary thyroid carcinoma based on nomogram of conventional ultrasound and contrast-enhanced ultrasound |
| zhangyu |
| (Wuhu Hospital Affiliated to East China Normal University) |
| Abstract: |
| Objective: To investigate the value of nomogram model based on conventional ultrasound and contrast-enhanced ultrasound in predicting cervical lymph node metastasis of papillary thyroid carcinoma (PTC) before operation.
Methods: The characteristics of conventional ultrasound and contrast-enhanced ultrasound of the primary focus of 216 patients with PTC diagnosed pathologically in Wuhu Hospital affiliated to East China Normal University and the Third Hospital of Peking University were analyzed retrospectively. The gold standard was whether there was cervical lymph node metastasis in the pathology after surgery According to whether there is lymph node metastasis, 54 patients were divided into metastatic group (LNM group) and non metastatic group (NLNM group). Univariate and multivariate Logistic regression analysis were used to screen independent risk factors for predicting lymph node metastasis.The joint prediction model is constructed based on independent risk factors and displayed in the form of nomogram.
Results: The results of single factor Logistic regression analysis showed that there were statistically significant differences between the two groups in nine indicators: gender (male), multifocal, maximum diameter(≥1cm),microcalcification, blood flow, enhancement,enhancement mode,superficial capsule,and puncture feel (P<0.05); multivariate Logistic regression analysis identified gender(male),multifocal,maximum diameterr(≥1cm),blood flow,enhancement,enhancement mode,and superficial capsule as independent risk factors,The area under the curve (AUC) of the nomogram prediction model was 0.822, which was statistically significant compared with other independent indicators (all P<0.05).Hosmer Lemeshow test showed that the model fitted well(2=8.298, P=0.405). The calibration curve shows that the predicted value is consistent with the measured value, and the clinical decision curve analysis(DCA) shows that the nomogram model has the largest clinical application value among all models.The AUC of five fold cross validation was 0.871 (95% CI: 0.781-0.961), 0.900 (95% CI: 0.840-0.959), 0.707 (95% CI: 0.581-0.834), 0.678 (95% CI: 0.556-0.800), 0.762 (95% CI: 0.654-0.870), and the average AUC was 0.784.
Conclusion: The nomogram model based on the characteristics of conventional ultrasound and contrast-enhanced ultrasound can effectively predict the cervical lymph node metastasis of PTC before operation. |
| Key words: Contrast-enhanced ultrasound Papillary thyroid carcinoma Cervical lymph node metastasis Nomogram |
