摘要目的:探讨常规超声特征、超声造影参数、血清抗甲状腺球蛋白抗体（TgAb）和促甲状腺激素（TSH）水平对甲状腺乳头状癌（PTC）中央区淋巴结转移的预测价值。方法:回顾性病例系列研究。分析山西省肿瘤医院2020年1月至2023年8月经术后病理学确诊为PTC的123例患者的临床资料。根据颈部淋巴结病理学结果将患者分为淋巴结转移组（58例）和淋巴结未转移组（65例）。采用常规超声观察结节并记录PTC结节征象，观察颈部淋巴结是否出现转移；采用超声造影术记录目标结节的增强模式，并计算峰值强度（PI）、达峰时间（TTP）及平均过渡时长（MTT）；采用放射性免疫法检测血清TSH、TgAb水平。采用logistic回归分析结果分别构建常规超声特征、超声造影参数、TSH、TgAb水平及四项联合对PTC中央区淋巴结转移的预测公式。以病理结果为金标准，绘制依据各预测公式判断PTC中央区淋巴结转移的受试者工作特征（ROC）曲线，分析各指标的预测效能。结果:淋巴结转移组和淋巴结未转移组患者基线资料比较，差异均无统计学意义（均 P>0.05）。两组中是否与被膜接触、回声质地是否均匀、是否有钙化灶、不同结节最大径的患者比例比较，差异均有统计学意义（均 P<0.05）。淋巴结转移组患者血清TSH、TgAb水平均高于未转移组，差异均有统计学意义（均 P<0.05）；淋巴结转移组患者结节超声造影参数PI、MTT、TTP均低于未转移组，差异均有统计学意义（均 P<0.05）。经logistic回归分析得到预测公式如下，常规超声特征：logit（ P）=1.017×与被膜接触-1.079×钙化灶+ 0.899×结节最大径；超声造影参数：logit（ P）=0.053×PI+0.034×MTT+0.080×TTP；超声造影参数联合TSH、TgAb：logit（ P）=0.062×PI+0.034×MTT+0.093×TTP-0.080×TSH-0.450×TgAb；四项联合：logit（P）=1.259×与被膜接触-0.921×钙化灶+0.955×结节最大径+0.054×PI+0.016×MTT+0.099×TTP-0.300×TSH-0.516×TgAb。常规超声特征预测PTC中央区淋巴结转移的曲线下面积（AUC）为0.74，超声造影参数的AUC为0.76，超声造影参数联合TSH、TgAb的AUC为0.64，四项联合的AUC为0.87。 结论:常规超声特征、超声造影参数联合血清TgAb和TSH水平对PTC中央区淋巴结转移具有较好的预测价值。

abstractsObjective:To investigate the value of conventional ultrasound features and contrast-enhanced ultrasound parameters combined with serum levels of anti-thyroglobulin antibody (TgAb) and thyroid stimulating hormone (TSH) in predicting central lymph node metastasis of papillary thyroid carcinoma (PTC).Methods:A retrospective case series study was conducted. The clinical data of 123 patients diagnosed with PTC by postoperative pathology at Shanxi Province Cancer Hospital from January 2020 to August 2023 were analyzed. According to the pathological results of cervical lymph nodes, the patients were divided into lymph node metastasis group (58 cases) and lymph node non-metastasis group (65 cases). The nodules were observed using conventional ultrasound and the signs of PTC nodules were recorded, and whether there was metastasis in the cervical lymph nodes was observed; the enhancement patterns of the target nodules were recorded using contrast-enhanced ultrasound technology, and the peak intensity (PI), time to peak (TTP) and mean transition time (MTT) were calculated; the serum TSH and TgAb levels were detected using radioimmunoassay. The results of logistic regression analysis were used to build formulas for predicting the metastasis of central lymph nodes in PTC based on conventional ultrasound features, contrast-enhanced ultrasound parameters, serum TSH level, serum TgAb level, and a combination of the 4 indicators. Using pathological results as the gold standard, receiver operating characteristic (ROC) curves of the indicators for predicting the metastasis of central lymph nodes in PTC were plotted to analyze the predictive performance of each indicator.Results:There were no statistically significant differences in baseline data between the lymph node metastasis group and the lymph node non-metastasis group (all P > 0.05). There were statistically significant differences in the proportions of patients with capsule contact, uniform echo texture, calcification and longest diameter of nodules between the two groups (all P < 0.05). The serum TSH and TgAb levels in patients of lymph node metastasis group were higher than those in patients of non-metastasis group, and the differences were statistically significant (both P < 0.05); the nodule contrast-enhanced ultrasound parameters PI, MTT and TTP in lymph node metastasis group were lower than those in non-metastasis group, and the differences were sttistically significant (all P < 0.05). Logistic regression analysis yielded the predictive formulas, conventional ultrasound features: logit ( P) = 1.017×capsule contact-1.079×calcification focus+0.899×longest diameter of nodule; contrast-enhanced ultrasound parameters: logit ( P) = 0.053×PI+0.034×MTT+0.080×TTP; contrast-enhanced ultrasound parameters combined with TSH and TgAb: logit( P)=0.062×PI+0.034×MTT+0.093×TTP-0.080×TSH-0.450×TgAb; a combination of the 4 indicators: logit( P) = 1.259×capsule contact-0.921×calcification focus+0.955×longest diameter of nodule+0.054×PI+0.016×MTT+0.099×TTP-0.300×TSH-0.516×TgAb. The area under the curve (AUC) for predicting central lymph node metastasis in PTC using conventional ultrasound features was 0.74, the AUC of contrast-enhanced ultrasound parameters was 0.76, the AUC of contrast-enhanced ultrasound parameters combined with TSH and TgAb was 0.64, the AUC of a combination of the 4 indicators was 0.87. Conclusions:The combination of conventional ultrasound features, contrast-enhanced ultrasound parameters and serum TgAb and TSH levels has good predictive value for central lymph node metastasis in PTC.