超声检查在分化型甲状腺癌术后患者诊断颈部淋巴结转移中的应用
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摘要
目的探讨分化型甲状腺癌(differentiated thyroid cancer,DTC)术后颈部淋巴结转移的超声声像图特征,评估超声检查的诊断性特征,提高其诊断率。方法 123例DTC术后患者,经细针穿刺细胞学或手术病理等检查结果证实的颈部淋巴结转移40例(观察组),未转移83例(对照组),从5个方面比较2组间治疗前颈部淋巴结超声声像图特征:淋巴结长径/短径之比、微小钙化、淋巴门结构是否存在、彩色多普勒血流显像情况、囊性或液化改变。组间计数资料比较采用χ~2检验,并分析超声诊断的灵敏度、特异性、准确性、特异度、阳性及阴性预测值。结果观察组中33例淋巴结长短径之比<2,对照组9例;观察组中微小钙化17例,对照组2例;淋巴门观察组中7例显示不清,对照组中2例出现显示不清;彩色血流观察组中12例出现血流丰富,对照组中出现3例;观察组4例出现囊性或液化区,对照组1例。此5种声像图表现的阳性比例分别为82.5%、42.5%、17.5%、30.0%及10.0%;颈部转移淋巴结患者超声下长径/短径<2明显高于未发生颈部淋巴结转移患者,差异均有统计学意义(均P<0.05)。超声诊断DTC术后颈部淋巴结转移的灵敏度、特异度、准确性、阳性预测值及阴性预测值分别为82.5%、74.7%、77.2%、61.1%及89.9%。结论超声检查对DTC术后颈部淋巴结转移诊断具有较高的灵敏度及特异度,可通过多种特征性的超声表现来诊断颈部淋巴结转移。
Objective To investigate the ultrasonographic features of cervical lymph node metastasis after differentiated thyroid cancer(DTC),evaluate the diagnostic features of ultrasonography,and improve the diagnostic rate.Methods A total of 123 patients with DTC were enrolled in this study.Forty cases of cervical lymph node metastasis confirmed by fine needle aspiration cytology or surgical pathology(observation group),83 cases without metastasis(control group),compared between the two groups.Ultrasound sonographic features of cervical lymph nodes before treatment:long-term/short-diameter ratio of lymph nodes,microcalcification,presence of lymphatic portal structures,color Doppler flow imaging,cystic or liquefaction changes.The comparison between the group count data was analyzed by χ~2,and the sensitivity,specificity,accuracy,specificity,positive and negative predictive value of the ultrasound diagnosis were analyzed.Results In the observation group,the ratio of length to diameter of 33 lymph nodes was < 2,and 9 cases in the control group.In the observation group,17 cases were microcalcification,2 cases in the control group,and 7 cases in the lymphatic observation group were unclear.Two cases showed unclear;12 cases in the color flow observation group showed abundant blood flow,and 3 cases in the control group.There were 4 cases in the cystic or liquefied area observation group and 1 case in the control group.The positive proportions of the five sonograms were 82.5%,42.5%,17.5%,30.0%,and 10.0%,respectively.The long-term/short-diameter < 2 in the cervical lymph node metastasis was significantly higher than that in the cervical lymph nodes.The patients with metastasis were statistically significant(P < 0.05).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of cervical lymph node metastasis after DTC were 82.5%,74.7%,77.2%,61.1% and 89.9%.Conclusion Ultrasonography has high sensitivity and specificity for the diagnosis of cervical lymph node metastasis after DTC.It can diagnose cervical lymph node metastasis through various characteristic ultrasound findings.
Objective To investigate the ultrasonographic features of cervical lymph node metastasis after differentiated thyroid cancer(DTC),evaluate the diagnostic features of ultrasonography,and improve the diagnostic rate.Methods A total of 123 patients with DTC were enrolled in this study.Forty cases of cervical lymph node metastasis confirmed by fine needle aspiration cytology or surgical pathology(observation group),83 cases without metastasis(control group),compared between the two groups.Ultrasound sonographic features of cervical lymph nodes before treatment:long-term/short-diameter ratio of lymph nodes,microcalcification,presence of lymphatic portal structures,color Doppler flow imaging,cystic or liquefaction changes.The comparison between the group count data was analyzed by χ~2,and the sensitivity,specificity,accuracy,specificity,positive and negative predictive value of the ultrasound diagnosis were analyzed.Results In the observation group,the ratio of length to diameter of 33 lymph nodes was < 2,and 9 cases in the control group.In the observation group,17 cases were microcalcification,2 cases in the control group,and 7 cases in the lymphatic observation group were unclear.Two cases showed unclear;12 cases in the color flow observation group showed abundant blood flow,and 3 cases in the control group.There were 4 cases in the cystic or liquefied area observation group and 1 case in the control group.The positive proportions of the five sonograms were 82.5%,42.5%,17.5%,30.0%,and 10.0%,respectively.The long-term/short-diameter < 2 in the cervical lymph node metastasis was significantly higher than that in the cervical lymph nodes.The patients with metastasis were statistically significant(P < 0.05).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of cervical lymph node metastasis after DTC were 82.5%,74.7%,77.2%,61.1% and 89.9%.Conclusion Ultrasonography has high sensitivity and specificity for the diagnosis of cervical lymph node metastasis after DTC.It can diagnose cervical lymph node metastasis through various characteristic ultrasound findings.
引文
[1]杨雷,王宁.甲状腺癌流行病学研究进展[J].中华预防医学杂志,2014,48(8):744-748.
[2]董芬,张彪,单广良.中国甲状腺癌的流行现状和影响因素[J].中国癌症杂志,2016,26(1):47-52.
[3]HAUGEN B R,ALEXANDER E K,BIBLE K C,et al.American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer:The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer[J].Thyroid,2015,26(1):1-133.
[4]林岩松,李娇.2015年美国甲状腺学会《成人甲状腺结节与分化型甲状腺癌诊治指南》解读:分化型甲状腺癌131I治疗新进展[J].中国癌症杂志,2016,26(1):1-12.
[5]MACHADO M R,TAVARES M R,BUCHPIGUEL C A,et al.Ultrasonographic Evaluation of Cervical Lymph Nodes in Thyroid Cancer[J].Otolaryngol Head Neck Surg,2017,156(2):263-271.
[6]范志娜,吴刚,袁建军.超声联合血清Tg、SPECT/CT诊断分化型甲状腺癌术后颈部淋巴结转移[J].中国医学影像技术,2014,30(3):362-365.
[7]代金,吴靖芳,薛刚.甲状腺癌的诊断现状[J].河北北方学院学报(自然科学版),2018,34(8):57-60.
[8]原韶玲,陈然.甲状腺结节和颈部淋巴结超声标准化报告及建议[J].中华医学超声杂志:电子版,2016,13(8):567-572.
[9]MU J,LIANG X,LI F,et al.Ultrasound features of extranodal extension in the metastatic cervical lymph nodes of papillary thyroid cancer:a case-control study[J].Cancer Biol Med,2018,15(2):171-177.
[10]LOTE H,BHOSLE J,THWAY K,et al.Epidermal growth factor mutation as a diagnostic and therapeutic target in metastatic poorly differentiated thyroid carcinoma:a case report and review of the literature[J].Case Rep Oncol,2014,7(2):393-400.
[11]LEPOUTRE-LUSSEY C,MADDAH D,GOLMARD J L,et al.Postoperative neck ultrasound and risk stratification in differentiated thyroid cancer patients with initial lymph node involvement[J].Eur J Endocrinol,2014,170(6):837-846.
[12]WONG R,FARRELL S G,GROSSMANN M.Thyroid nodules:diagnosis and management[J].Med J Aust,2018,209(2):92-98.
[13]YOU J,CHEN J,XIANG F,et al.The value of quantitative shear wave elastography in differentiating the cervical lymph nodes in patients with thyroid nodules[J].J Med Ultrason,2018,45(2):251-259.
[14]郭艳,潘如凤,宋伟,等.彩色多普勒超声对甲状腺癌诊断的临床应用价值[J].中华全科医学,2013,11(9):1454-1455,1495.
[15]孟君,杨高怡,闻波平,等.钙化灶在颈部结核性淋巴结与甲状腺乳头状癌转移性淋巴结中的超声特征[J].中国超声医学杂志,2015,31(6):487-489.
[2]董芬,张彪,单广良.中国甲状腺癌的流行现状和影响因素[J].中国癌症杂志,2016,26(1):47-52.
[3]HAUGEN B R,ALEXANDER E K,BIBLE K C,et al.American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer:The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer[J].Thyroid,2015,26(1):1-133.
[4]林岩松,李娇.2015年美国甲状腺学会《成人甲状腺结节与分化型甲状腺癌诊治指南》解读:分化型甲状腺癌131I治疗新进展[J].中国癌症杂志,2016,26(1):1-12.
[5]MACHADO M R,TAVARES M R,BUCHPIGUEL C A,et al.Ultrasonographic Evaluation of Cervical Lymph Nodes in Thyroid Cancer[J].Otolaryngol Head Neck Surg,2017,156(2):263-271.
[6]范志娜,吴刚,袁建军.超声联合血清Tg、SPECT/CT诊断分化型甲状腺癌术后颈部淋巴结转移[J].中国医学影像技术,2014,30(3):362-365.
[7]代金,吴靖芳,薛刚.甲状腺癌的诊断现状[J].河北北方学院学报(自然科学版),2018,34(8):57-60.
[8]原韶玲,陈然.甲状腺结节和颈部淋巴结超声标准化报告及建议[J].中华医学超声杂志:电子版,2016,13(8):567-572.
[9]MU J,LIANG X,LI F,et al.Ultrasound features of extranodal extension in the metastatic cervical lymph nodes of papillary thyroid cancer:a case-control study[J].Cancer Biol Med,2018,15(2):171-177.
[10]LOTE H,BHOSLE J,THWAY K,et al.Epidermal growth factor mutation as a diagnostic and therapeutic target in metastatic poorly differentiated thyroid carcinoma:a case report and review of the literature[J].Case Rep Oncol,2014,7(2):393-400.
[11]LEPOUTRE-LUSSEY C,MADDAH D,GOLMARD J L,et al.Postoperative neck ultrasound and risk stratification in differentiated thyroid cancer patients with initial lymph node involvement[J].Eur J Endocrinol,2014,170(6):837-846.
[12]WONG R,FARRELL S G,GROSSMANN M.Thyroid nodules:diagnosis and management[J].Med J Aust,2018,209(2):92-98.
[13]YOU J,CHEN J,XIANG F,et al.The value of quantitative shear wave elastography in differentiating the cervical lymph nodes in patients with thyroid nodules[J].J Med Ultrason,2018,45(2):251-259.
[14]郭艳,潘如凤,宋伟,等.彩色多普勒超声对甲状腺癌诊断的临床应用价值[J].中华全科医学,2013,11(9):1454-1455,1495.
[15]孟君,杨高怡,闻波平,等.钙化灶在颈部结核性淋巴结与甲状腺乳头状癌转移性淋巴结中的超声特征[J].中国超声医学杂志,2015,31(6):487-489.