超声造影诊断甲状腺乳头状癌术后颈部淋巴结转移的病理学依据
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摘要
目的探讨甲状腺乳头状癌术后颈部转移性淋巴结的超声造影模式,并分析其病理学依据。方法对40例接受甲状腺乳头状癌手术切除后的患者颈部出现的56个异常淋巴结行超声造影检查,之后行超声引导下细针穿刺,并分析二维及超声造影各项特征与转移性淋巴结的病理关联性。结果细胞学证实56个颈部淋巴结中,26例患者的35个淋巴结为转移性淋巴结,各项超声特征中,超声造影的增强均匀性、增强强度、增强方式,这三者在甲状腺乳头状癌术后颈部淋巴结转移的诊断中更具有相关性。结论甲状腺乳头状癌术后的颈部转移性淋巴结超声造影表现为不均性高增强。
Objective To explore the CEUS enhanced pattern of the cervical lymph node metastasis of PTC,and analysis the pathological basis.Methods Fifty-six abnormal cervical lymph nodes(ACLN)in 40 PTC patients who received thyroidectomy were performed CEUS.Then fine needle aspiration biopsy(FNAB)was taken to confirm pathological results,and a multivariate analysis was performed to analysis the sonographic feature and CLNM.ResultsThirty five lymph nodes were confirmed metastasis of PTC by FNAB.Three statistically significant features(homogeneity,intensity and pattern of CEUS)were closely related with CLNM by multivariate analysis.Conclusions Heterogeneous enhancement was useful for predicting CLNM of PTC after operation.
Objective To explore the CEUS enhanced pattern of the cervical lymph node metastasis of PTC,and analysis the pathological basis.Methods Fifty-six abnormal cervical lymph nodes(ACLN)in 40 PTC patients who received thyroidectomy were performed CEUS.Then fine needle aspiration biopsy(FNAB)was taken to confirm pathological results,and a multivariate analysis was performed to analysis the sonographic feature and CLNM.ResultsThirty five lymph nodes were confirmed metastasis of PTC by FNAB.Three statistically significant features(homogeneity,intensity and pattern of CEUS)were closely related with CLNM by multivariate analysis.Conclusions Heterogeneous enhancement was useful for predicting CLNM of PTC after operation.
引文
[1]黄丽平,俞丽云,薛恩生,等.甲状腺乳头状癌颈部淋巴结转移及转移区域相关因素分析[J].中国超声医学杂志,2015,31(3):207-210.
[2] XU J M,XU X H,XU H,et al.Prediction of cervical lymph node metastasis in patients with papillary thyroid cancer using combined conventional ultrasound,strain elastography,and acoustic radiation force impulse(ARFI)elastography[J].European Radiology,2016,26(8):2611-2622.
[3]陈霰,徐丽伟,华娟,等.超声造影在甲状腺微小乳头状癌诊断中的应用价值[J].中国超声医学杂志,2015,31(4):375-378.
[4]刘文英,杨薇,严昆,等.超声结合增强CT对甲状腺癌术后局部复发/残留的诊断价值[J].中华超声影像学杂志,2013,22(9):776-779.
[5] CHEN J,LI X L,ZHAO C K,et al.Conventional Ultrasound,Immunohistochemical Factors and BRAFV600EMutation in Predicting Central Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma[J]. Ultrasound Med Biol,2018,44(11):2296-2306.
[6]张雪云,聂芳,吕文豪,等.超声造影对结核性淋巴结与转移性淋巴结的鉴别诊断价值[J].中国超声医学杂志,2018,34(5):403-406.
[7]陈霰,张雪君,陈敬一,等.手动活检结合超声造影在浅表肿大淋巴结诊断中的应用价值[J].中国超声医学杂志,2018,34(4):331-333.
[8]林周谊,张群霞,冉海涛.超声联合超声造影诊断乳腺癌转移性前哨淋巴结的应用价值[J].中国超声医学杂志,2018,34(5):407-409.
[9]洪玉蓉,刘学明.颈部转移性淋巴结的超声造影表现分析[J].中国超声医学杂志,2008,24(6):520-522.
[10] RUBALTELLIA L,STRAMARE R.Evaluation of lymph node perfusion with contrast-enhanced ultrasound in metastatic and lymphomatous disease[J].Ultrasound Med Biol,2006,32(5S):14.
[11]李佳,胡兵.正常甲状腺、颈总动脉、颈内静脉实时灰阶超声造影时相特点的初步观察及分析[J].中国超声医学杂志,2008,24(7):601-605.
[2] XU J M,XU X H,XU H,et al.Prediction of cervical lymph node metastasis in patients with papillary thyroid cancer using combined conventional ultrasound,strain elastography,and acoustic radiation force impulse(ARFI)elastography[J].European Radiology,2016,26(8):2611-2622.
[3]陈霰,徐丽伟,华娟,等.超声造影在甲状腺微小乳头状癌诊断中的应用价值[J].中国超声医学杂志,2015,31(4):375-378.
[4]刘文英,杨薇,严昆,等.超声结合增强CT对甲状腺癌术后局部复发/残留的诊断价值[J].中华超声影像学杂志,2013,22(9):776-779.
[5] CHEN J,LI X L,ZHAO C K,et al.Conventional Ultrasound,Immunohistochemical Factors and BRAFV600EMutation in Predicting Central Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma[J]. Ultrasound Med Biol,2018,44(11):2296-2306.
[6]张雪云,聂芳,吕文豪,等.超声造影对结核性淋巴结与转移性淋巴结的鉴别诊断价值[J].中国超声医学杂志,2018,34(5):403-406.
[7]陈霰,张雪君,陈敬一,等.手动活检结合超声造影在浅表肿大淋巴结诊断中的应用价值[J].中国超声医学杂志,2018,34(4):331-333.
[8]林周谊,张群霞,冉海涛.超声联合超声造影诊断乳腺癌转移性前哨淋巴结的应用价值[J].中国超声医学杂志,2018,34(5):407-409.
[9]洪玉蓉,刘学明.颈部转移性淋巴结的超声造影表现分析[J].中国超声医学杂志,2008,24(6):520-522.
[10] RUBALTELLIA L,STRAMARE R.Evaluation of lymph node perfusion with contrast-enhanced ultrasound in metastatic and lymphomatous disease[J].Ultrasound Med Biol,2006,32(5S):14.
[11]李佳,胡兵.正常甲状腺、颈总动脉、颈内静脉实时灰阶超声造影时相特点的初步观察及分析[J].中国超声医学杂志,2008,24(7):601-605.