细针穿刺洗脱液Tg测定阳性相关的甲状腺淋巴结超声特征分析

doi:10.16150/j.1671-2870.2023.03.08

摘要/Abstract

摘要：

目的：探讨与甲状腺乳头状癌（papillary thyroid carcinoma，PTC）可疑转移淋巴结细针穿刺洗脱液甲状腺球蛋白测定（fine needle aspiration thyroglobulin，FNA-Tg）阳性相关的淋巴结超声特征。方法：选取2019年1月至2021年12月间就诊的87例PTC患者，对共109个可疑转移淋巴结行细针穿刺细胞学检查，并行FNA-Tg测定,以淋巴结FNA-Tg/血清Tg>1定义为转移阳性，FNA-Tg/血清Tg≤1定义为转移阴性。所有可疑淋巴结均具有可疑转移的超声征象，包括局部高回声、囊性变、淋巴门结构缺失、微钙化、长径/短径<2、边缘血供，应用单因素及多因素Logistic回归分析这些可疑超声征象与FNA-Tg检测阳性间的相关性。结果：109个可疑淋巴结中，FNA-Tg检测阴性淋巴结有30个，FNA-Tg检测阳性淋巴结有79个。可疑转移淋巴结超声特征中，局部高回声及囊性变是FNA-Tg检测结果阳性的独立危险因素(P<0.05)。结论：对常规超声具有局部高回声及囊性变的可疑转移淋巴结，可选择在行细针穿刺细胞学检查的同时，行FNA-Tg测定，以提高PTC转移淋巴结的检出率，为临床提供更准确的诊断信息。

关键词: 淋巴结, 甲状腺球蛋白, 超声特征

Abstract:

Objective: To explore the ultrasonographic characteristics of lymph nodes associated with positive fine-needle aspiration thyroglobulin (FNA-Tg) in eluent for suspected metastatic lymph nodes of papillary thyroid carcinoma (PTC). Methods: A total of 87 patients with PTC who were treated between January 2019 and December 2021 were selected, with 109 suspected metastatic lymph nodes examined by fine needle aspiration cytology and detected for FNA-Tg. Those with FNA-Tg/serum Tg>1 was defined as metastastic lymph nodes, and with FNA-Tg/serum Tg≤1 was defined as non-metastastic lymph nodes. All suspicious lymph nodes had ultrasonographic signs of suspicious metastasis, including local hyperechogenicity, cystic change, absence of hilum, microcalcification, solbiati index <2, and marginal blood supply. Univariate and multivariate logistic regression were applied to analyze the correlation of these suspicious lymph node ultrasound signs with positive FNA-Tg. Results: Among 109 suspected metastatic lymph nodes, 30 lymph nodes were FNA-Tg negative and 79 were FNA-Tg positive. Among the ultrasonographic features of suspected metastatic lymph nodes, local hyperecho and cystic change were independent risk factors for positive FNA-Tg detection(P<0.05). Conclusions: For suspected metastatic lymph nodes with local hyperecho and cystic changes in conventional ultrasound, FNA-Tg determination can be performed along with fine needle aspiration cytology examination to improve the detection rate of PTC metastatic lymph nodes,providing more accurate diagnostic information for the clinic.

Key words: Lymphnodes, Thyroglobulin, Sonographic features

中图分类号:

况李君, 陶玲玲, 詹维伟, 李伟伟, 樊金芳, 周伟. 细针穿刺洗脱液Tg测定阳性相关的甲状腺淋巴结超声特征分析[J]. 诊断学理论与实践, 2023, 22(03): 255-260.

KUANG Lijun, TAO Lingling, ZHAN Weiwei, LI Weiwei, FAN Jinfang, ZHOU Wei. Analysis of ultrasonographic features of thyroid lymph nodes associated with positive thyroglobulin in fine needle aspiration eluent of metastatic lymph nodes[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(03): 255-260.

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Item	FNA-Tg（-）（n=30）	FNA-Tg（+）（n=79）	P value
Sex			0.015
Male	10	47
Female	20	32
Age	39.30±11.35	38.35±11.29	0.422
FNA-Tg（ng/mL）	0.09(0.04-1.48)	1024(343-5 996)	<0.001
Serum Tg （ng/mL）	4.71(0.88-21.83)	10.58(3.78-27.99)	0.040
FT₃（pmol/L）	4.43±0.65	4.43±0.62	0.779
FT₄(pmol/L)	15.91±3.39	17.16±13.73	0.493
TSH（μIU/mL）	1.77±1.57	1.64±1.33	0.087
TgAb（IU/mL）	9.89(1.57-36.42)	3.46(1.76-18.99)	0.214

Ultrasound features	B	S.E.	Wald	df	sig	Exp（B）	Exp（B）95%
Ultrasound features	B	S.E.	Wald	df	sig	Exp（B）	Lower limit	Upper limit
Absence of hilum	0.440	0.736	0.358	1	0.550	1.552	0.367	6.564
Hyperechoic content	1.575	0.733	4.612	1	0.032	4.832	1.148	20.329
Microcalcification	0.734	0.600	1.497	1	0.221	2.084	0.643	6.755
Lymph nodes with cystic content	1.423	0.711	4.005	1	0.045	4.150	1.030	16.728
Peripheral hypervascularity	0.942	0.803	5.841	1	0.056	6.972	1.444	33.673