摘要
目的探讨术前超声诊断分化型甲状腺癌(DTC)颈中央区及颈侧区淋巴结转移的临床价值。方法回顾性分析2017年4月至2018年8月术后病理证实的186例DTC患者,所有患者均于山东大学齐鲁医院(青岛)超声科行术前超声检查,并于耳鼻咽喉头颈外科行颈中央区淋巴结清扫术,其中71例同时行颈侧区择区淋巴结清扫术。以石蜡切片病理结果为金标准,计算术前超声诊断颈中央区淋巴结转移及颈侧区淋巴结转移的敏感度、特异度、阳性预测值(PPV)和阴性预测值(NPV)。根据患者有无桥本甲状腺炎(CLT),将所有病例分为两组,A组合并CLT,B组不合并CLT;分别计算两组超声诊断中央区淋巴结转移的敏感度、特异度、PPV、NPV。结果术前超声诊断甲状腺癌颈中央区及颈侧区淋巴结转移的敏感度分别为:68.9%、95.3%,特异度分别为:56.3%、57.1%,PPV分别为:75.0%、95.3%,NPV分别为:48.6%、57.1%。A组(60例)与B组(126例),术前超声对颈中央区淋巴结转移诊断的敏感度分别为:85.0%、62.5%,特异度分别为:35.0%、67.4%,PPV分别为:72.3%、76.9%,NPV分别为:53.8%、50.8%。结论术前超声检查对DTC颈中央区及颈侧区淋巴结转移的诊断有价值,对颈侧区的诊断准确性高于中央区。合并CLT的DTC患者,超声对颈中央区淋巴结转移的诊断准确性低于不合并CLT的患者。
Objective To investigate the clinical value of preoperative ultrasonography in detecting central compartment and lateral neck lymph node metastasis. Methods In total,186 consecutive patients with pathologically proven differentiated thyroid cancer were involved in this retrospective study. All patients underwent operative US examination in the Department of Ultrasound and central-compartmental lymph node dissection in the Department of Otorhinolaryngology Head and Neck Surgery in Qilu Hospital of Shandong University( Qingdao),while 71 of them underwent lateral neck compartmental lymph node dissection between April 2017 and August 2018. According to the gold standard of biopsy,the sensitivity,specificity,positive predictive value( PPV),and negative predictive value( NPV) were calculated using SPSS 20. 0 statistical software. All the patients were divided into two groups;groups A and B included patients with or without chronic lymphocytic thyroiditis( CLT). The sensitivity,specificity,PPV,and NPV of central neck compartmental lymph node metastasis detected using US were calculated. Results The sensitivity,specificity,PPV,and NPV of central compartmental lymph node metastasis detected using US were 68.9%,56.3%,75.0%,and 48.6%,respectively; those of lateral neck compartmental lymph node metastasis detected using US were 95.3%,57.1%,95.3%,and 57.1%,respectively. The sensitivity,specificity,PPV,and NPV in group A were 85.0%,35.0%,72.3%,and 53.8%,respectively; those in group B were 62.5%,67.4%,76.9%,and 50.8%,respectively. Conclusion Preoperative US for central and lateral neck lymph node metastasis is valuable for the management of cervical lymph node dissection. The diagnosis of lateral neck lymph node metastasis is much more accurate than that of central neck lymph node metastasis,while the diagnosis of central neck lymph node metastasis in patients with CLT is more accurate than that in patients without CLT.
引文
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