超声在甲状腺癌颈部淋巴结转移临床诊断中的实用价值

doi:10.16150/j.1671-2870.2019.06.011

摘要/Abstract

摘要：

目的：探讨超声检查在甲状腺癌颈部淋巴结转移诊断中的实用价值。方法：回顾性分析经手术病理证实为甲状腺癌并行颈部淋巴结清扫术的52例患者（包括乳头状癌43例,滤泡状癌4例,髓样癌4例,未分化癌1例）共70个颈部淋巴结的临床资料,术前所有患者均行超声检查,采用灰阶超声观察淋巴结形态、淋巴结实质内部回声、淋巴门存在的情况,用彩色多普勒超声观察淋巴结内的血流分布情况。以淋巴结长短径比<2、淋巴门消失、淋巴结内存在钙化、囊性变、高回声、淋巴结血供丰富作为可疑特征,并按照颈部淋巴结分区记录淋巴结分布,对颈部淋巴结转移情况进行评估,并以术后病理诊断为金标准,进行统计学分析,评价超声检查在甲状腺癌颈部淋巴结转移临床诊断中的实用价值。结果：70个颈部淋巴结经病理证实其中36个为甲状腺癌转移,超声检查诊断甲状腺癌颈部淋巴结转移的灵敏度为86.11%,特异度为100%,阳性预测值（positive predict value,PPV）为100%,阴性预测值（negative predict value,NPV）为87.17%。其中,超声检查诊断对甲状腺癌颈部中央区淋巴结转移的灵敏度为78.95%,NPV为85.19%,低于对颈侧区淋巴结转移的诊断灵敏度（94.12%）、NPV（91.67%）。不同病理类型甲状腺癌颈部转移性淋巴结有不同的超声特征,大部分表现为长短径比<2（28/31）、淋巴门消失（26/31）、血供丰富（18/31）,其中乳头状癌转移性淋巴结表现较为多样,滤泡状癌转移性淋巴结未见钙化、囊性变及高回声(0/3),髓样癌转移性淋巴结多见钙化（3/4）、血供丰富（4/4）、未见囊性变（0/4）,未分化癌转移性淋巴结血供丰富（1/1）,未见钙化、囊性变及高回声（0/1）。结论：超声检查在甲状腺癌颈部淋巴结转移临床诊断中具有实用价值,能够对颈部淋巴结转移作出准确诊断,指导临床制定合适的诊疗方案,而其对颈侧区淋巴结转移的诊断准确率高于中央区。

关键词: 超声检查, 甲状腺癌, 颈部淋巴结

Abstract:

Objective: To study the clinical value of ultrasonography in diagnosis of cervical lymph node metastasis of thyroid cancer. Methods: The data of 70 cervical lymph nodes of 52 pathologically confirmed thyroid cancer patients (papillary carcinoma 43 cases, follicular carcinoma 4 cases, medullary carcinoma 4 cases, undifferentiated carcinoma 1 case) were retrospectively analyzed. All patients had ultrasonographic examination taken before operation. Gray-scale ultrasound was used to observe the morphology of lymph nodes, the internal echo, and the existence of lymph node hilum. Color doppler ultrasonography was used to detect blood flow distribution of lymph node. Lymph node length to diameter ratio <2, disappearance of lymph node hilum, calcification, cystic change, rich blood supply, and high echo were considered as suspicious character. The distribution of lymph nodes was recorded according to cervical lymph node area, and the lymph node metastasis in neck was assessed. Postoperative pathological diagnosis was taken as gold standard for evaluating the value of ultrasonography in diagnosis of lymph node metastasis of thyroid cancer in neck. Results: Seventy cervical lymph nodes were confirmed by pathology, among which 36 were thyroid cancer metastasis. The sensitivity and specificity of ultrasonography for diagnosis of cervical lymph node metastasis of thyroid cancer were 86.11% and 100%,respectively; the positive predictive value (PPV) was 100%, and negative predictive value (NPV) was 87.17%. The sensitivity of ultrasonography for diagnosing lymph node metastasis in central cervical region was 78.95%, NPV was 85.19%, lower than that of lymph node metastasis in lateral region (sensitivity 94.12%, NPV 91.67%). Cervical metastatic lymph nodes of different pathological types of thyroid carcinoma had different ultrasonographic features. Most of the metastatic lymph nodes had a length to diameter ratio <2 (28/31), disappearance of lymph node hilum (26/31), and rich blood supply (18/31). The feature of papillary carcinoma metastatic lymph nodes was diverse; calcification, cystic change and high echo were not seen in follicular carcinoma metastatic lymph nodes(0/3); medullary carcinoma metastatic lymph nodes were often calcified (3/4) and rich in blood supply (4/4), and cystic change was not seen (0/4); anaplastic carcinoma metastatic lymph nodes was rich in blood supply (1/1), and no calcification, cystic change and high echo(0/1). Conclusions: Ultrasonography is of practical value in the clinical diagnosis of cervical lymph node metastasis of thyroid cancer, which can make an accurate diagnosis and guide the establishing of appropriate treatment program. The diagnostic accuracy for metastatic lymph nodes in cervical lateral region is higher than that in central region.

Key words: Ultrasonography, Thyroid carcinoma, Cervical lymph node

中图分类号:

R736.1

顾耀耀, 倪雪君. 超声在甲状腺癌颈部淋巴结转移临床诊断中的实用价值[J]. 诊断学理论与实践, 2019, 18(06): 662-667.

GU Yaoyao, NI Xuejun. Clinical value of ultrasonography in diagnosis of cervical lymph node metastasis of thyroid cancer[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(06): 662-667.

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病理类型	超声诊断淋巴结转移	病理诊断淋巴结转移
乳头状癌（60个）	23	27
滤泡状癌（4个）	3	3
髓样癌（5个）	4	5
未分化癌（1个）	1	1
合计（70个）	31	36