Study On The Establishment Of Risk Score System And Diagnostic Efficacy Of FNA-Tg Measurement Combined With Ultrasonic Characteristic Parameters In Differentiated Thyroid Carcinoma With Cervical Metastatic Lymph Nodes

Objectives:To explore the application of high-frequency ultrasound-guided fine-needle aspiration eluate-thyroglobulin(FNA-Tg)level of cervical metastatic lymph nodes in differentiated thyroid carcinoma(DTC)combined with ultrasound characteristic parameters in the establishment of metastasis risk score system and the diagnostic efficacy.Methods:1.A total of 92 patients with DTC confirmed by pathology in Affiliated Hospital of North Sichuan Medical College from June 2019 to December 2020 were enrolled,aged from 21 to 74 years old,including 22 males and an average age of 52.0 ±4.0 years old.According to whether the cervical lymph nodes have metastasized,they were divided into metastatic lymph node(MLN)group and non metastatic lymph node(NMLN)group,including 72 lymph nodes in MLN group and 30 lymph nodes in NMLN group,a total of 102 suspected abnormal lymph nodes were included.2.To develope a questionnaire and collect the basic clinical data including gender、age、living habits、family history、drug history and radiation history and so on.3.The conventional high-frequency and ultra-micro blood flow ultrasound imaging technology were used to obtain and record the long diameter(L)、short diameter(S)、L/S ratio、parenchymal echo、whether it was accompanied by calcification、whether it was accompanied by cystic degeneration、ultra-sensitive micro blood flow imaging lymph node perfusion pattern and hemodynamics、lymphatic hilum and suspicious ipsilateral cervical lymph node distribution area group information in detail;lymph node FNA under high-frequency ultrasound guided,chemiluminescence immunoassay was used to detect the eluate in the eluate Tg content,ultrasound-guided puncture biopsy of lymph node tissues and pathological information was collected.4.Statistical analysis was performed by using SPSS23.0 and MedCalc19.1 software.The count data was expressed as a percentage.The measurement data was tested for normality and conformed to the normal distribution data(x score).The comparison between groups was performed by independent sample t test and categorical variable data.X2 test was performed,multivariate Logistic regression analysis was used for meaningful parameters,and the regression equation was established according to the logistic regression results to establish the risk prediction score.Calculate the diagnostic efficacy of the combined use of FNA-Tg and ultrasound characteristic parameters.Results:1.Compared with NMLN group,the univariate analysis showed that S of lymph nodes increased,L/S ratio decreased,hyperechoic lymph nodes,microcalcification,cystic degeneration,mixed perfusion pattern of lymph node and RI in MLN group was significantly higher than that in NMLN group,and the number of suspicious cervical lymph node metastasis detected by ultrasound was significantly more than that in NMLN group(P<0.05).2.The sensitivity of single parameter diagnosis of lymph node ultrasound characteristics ranged from 67.4%to 90.2%,and the order from high to low was cluster hyperechoic lymph nodes>with microcalcification>with cystic changed>the number of suspicious lymph node metastasis detected by ultrasound≥2>blood flow mixed perfusion>RI>S>L/S;The specificity distribution ranged from 62.5%to 85.2%,and the order from high to low was RI>the number of suspicious lymph node metastasis groups detected by ultrasound ≥2>S>L/S>with microcalcification>lymph node mass hyperechogenicity>with cystic degeneration>blood flow in mixed perfusion mode.3.Ten parameters with statistically significant differences in general clinical data and ultrasound characteristics of cervical lymph nodes were brought into the logistic regression analysis.According to the results of logistic regression model,the risk score methods was established.AUC=0.934,and its 95%confidence interval was(0.340,0.951),and total score of 3 was taken as the critical value.FNA-Tg combined with ultrasound characteristics of cervical lymph nodes was used for combined diagnosis.Compared with single diagnostic method,FNA-Tg combined with 1-2 ultrasonic characteristic parameters of cervical lymph nodes(Risk score 1-2)could improve the diagnostic efficiency in DTC with metastatic lymph nodes significantly.Conclusions:Ultrasonic diagnosed cervical metastatic lymph nodes showed high sensitivity and specificity when≥3 ultrasound characteristic parameters(Risk score 3)were abnormal.However,when the ultrasound characteristic parameters(Risk score 0-2)only showed 0-2 abnormal changes,FNA-Tg positive combined with ultrasound characteristic parameters could significantly improve the detection rate of cervical metastatic lymph nodes in DTC.