超声对甲状腺乳头状癌颈部淋巴结转移诊断价值的研究
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摘要
目的：探讨超声检查对甲状腺乳头状癌颈部淋巴结转移的诊断价值。方法：回顾性分析2009年至2010年全年在本院诊断为甲状腺乳头状癌伴颈部淋巴结肿大的患者共154例,应用SPSS17.0统计学软件分析：超声对甲状腺乳头状癌中的转移性淋巴结的形态特征、边界及内部回声特征及淋巴结内部血供特点的计数资料进行卡方检验。结果：154例甲状腺乳头状癌患者中超声共探及颈部淋巴结326枚。经手术或穿刺后的病理诊断甲状腺乳头状癌淋巴结转移的126例患者,转移性淋巴结为267枚,非淋巴结转移的为28例,非转移性淋巴结的为59枚。超声诊断淋巴结转移的符合率为81.8%,甲状腺乳头状癌转移性淋巴结的纵横比(长径／短径)<2(85.0%)、淋巴结内部的回声不均匀(75.3%)、淋巴结的边界欠规则(74.2%)、淋巴结内可见细小钙化(53.6%)。甲状腺乳头状癌颈部转移性淋巴结组和非转移性淋巴结组之间上述超声指标的差异均具有统计学意义(P<0.05)。甲状腺乳头状癌颈部转移性淋巴结血流分布较丰富,高于非转移性淋巴结组(P<0.05)。结论：甲状腺乳头状癌颈部转移性淋巴结多呈圆形或类圆形,纵横比(长径／短径)<2,而融合的淋巴结是诊断甲状腺乳头状癌颈部淋巴结有无转移的重要特征之一,颈部淋巴结内见细小钙化高度提示甲状腺乳头状癌颈部淋巴结转移。超声是诊断甲状腺乳头状癌颈部淋巴结转移的一种简便、有效的方法,研究结果对指导临床较准确进行超声诊断和提高确诊水平具有重要意义。
Objective:To study the ultrasonography thyroid papillary carcinoma cervical lymph node metastases diagnostic value.Methods:a retrospective analysis by 2010 year 2009 at our hospital diagnosed with thyroid papillary carcinoma patients with cervical lymph node enlargement of 154 cases of application SPSS 17.0 statistics software analysis: ultrasonology thyroid papillary carcinoma metastatic lymph nodes in the morphological characteristics, boundary and internal echographic features and nodal internal blood supply characteristics of counting chi-square test data. Results:154 patients with thyroid papillary carcinoma patients were agent and ultrasonic cervical lymph nodes 326 medal. By operation or puncture after pathological diagnosis thyroid papillary carcinoma lymph node metastasis of 126 patients, metastatic lymph nodes for 267 pieces, the lymph node metastasis 28 cases, for non-metastatic lymph node for 59 medal. Ultrasound diagnosis lymph node metastasis accuracy 81.8%, thyroid papillary carcinoma metastatic lymph node aspect ratios (length-diameter/short diameter)<2(85.0%), lymph node is the echo of the internal non-uniform (75.3%), lymph node boundary owe rules (74.2%), lymph nodes can be seen in tiny calcification (53.6%). Thyroid papillary carcinoma metastatic lymph node group and neck non-metastatic lymph node group differences between the ultrasonic index was statistically significant (P<0.05). Thyroid papillary carcinoma cervical lymph node metastases of blood flow distribution is more abundant, higher than non-metastatic lymph node group (P<0.05).Conclusion:thyroid papillary carcinoma cervical lymph node metastases of a round or class round, aspect ratios (length-diameter/short diameter)< 2, and fusion of lymph node is diagnostic thyroid papillary carcinoma or cervical lymph node metastasis, one of the important characteristics of cervical lymph node within see tiny calcification highly suggestive of thyroid papillary carcinoma cervical lymph node metastases. Ultrasound is the thyroid papillary carcinoma cervical lymph node metastases a simple and effective method, the results of the study on clinical guidelines for accurate ultrasound diagnosis and improve diagnosis level to have the important meaning.
Objective:To study the ultrasonography thyroid papillary carcinoma cervical lymph node metastases diagnostic value.Methods:a retrospective analysis by 2010 year 2009 at our hospital diagnosed with thyroid papillary carcinoma patients with cervical lymph node enlargement of 154 cases of application SPSS 17.0 statistics software analysis: ultrasonology thyroid papillary carcinoma metastatic lymph nodes in the morphological characteristics, boundary and internal echographic features and nodal internal blood supply characteristics of counting chi-square test data. Results:154 patients with thyroid papillary carcinoma patients were agent and ultrasonic cervical lymph nodes 326 medal. By operation or puncture after pathological diagnosis thyroid papillary carcinoma lymph node metastasis of 126 patients, metastatic lymph nodes for 267 pieces, the lymph node metastasis 28 cases, for non-metastatic lymph node for 59 medal. Ultrasound diagnosis lymph node metastasis accuracy 81.8%, thyroid papillary carcinoma metastatic lymph node aspect ratios (length-diameter/short diameter)<2(85.0%), lymph node is the echo of the internal non-uniform (75.3%), lymph node boundary owe rules (74.2%), lymph nodes can be seen in tiny calcification (53.6%). Thyroid papillary carcinoma metastatic lymph node group and neck non-metastatic lymph node group differences between the ultrasonic index was statistically significant (P<0.05). Thyroid papillary carcinoma cervical lymph node metastases of blood flow distribution is more abundant, higher than non-metastatic lymph node group (P<0.05).Conclusion:thyroid papillary carcinoma cervical lymph node metastases of a round or class round, aspect ratios (length-diameter/short diameter)< 2, and fusion of lymph node is diagnostic thyroid papillary carcinoma or cervical lymph node metastasis, one of the important characteristics of cervical lymph node within see tiny calcification highly suggestive of thyroid papillary carcinoma cervical lymph node metastases. Ultrasound is the thyroid papillary carcinoma cervical lymph node metastases a simple and effective method, the results of the study on clinical guidelines for accurate ultrasound diagnosis and improve diagnosis level to have the important meaning.
引文
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[2]徐薪,纪小龙.人淋巴结支架中血管三维重建的病理意义.中国体视学与图像分析,2002(3)：158-161
[3]侯新燕,张武.浅表淋巴结病变彩色超声检查的临床应用.中国超声医学杂志,1996,12(S1)：38-42
[4]陈建荣,聂月娟,吕国兴.超声在浅表淋巴结病变检查中的应用价值.中国超声医学杂志,2000,16(8)：631-633
[5]Ho SS,Ahuja AT,Kew J,et al.Differentiation of lymphadenopathy in different forms of carcinorma with Doppler Sonography.Clin Radiol,2000,55(8):627-631
[6]Adibelli ZH,Unal G,Gul E,et al.Differentiration of benign and malignant cerical lymph nodes.Value of B-mode and color Doppler sonography.Eur J Radioc,1998, 28(3):230-234
[7]Yang WT.Matrew elic Color Doppler flow in normal axillary lymph nodes.Br J Radiol,1998,71(844):381-383
[8]唐石初,吴泽惠,杨通明,等.彩色多普勒能量图在浅表淋巴结病变诊断中的应用.中国超声医学杂志,2001,18(1)：62-64
[9]石木兰,韦嘉瑚,王正颜.肿瘤诊断影像学.合肥：安徽科学技术出版社,1995：18-25
[10]陈文,张武,苗立英,等.甲状腺恶性肿瘤的二维及彩色多普勒超声征象及其临床意义.中国超声医学杂志,2000,16(7)：495-497
[11]Alder DD,Carson PL,Rubin JVI,et al Doppler Ultrasound color flower imaging in the study of breast cancer preplin inany finding[J].Ultrasound Med Biol,1990,16: 553-559
[12]CappelliC,Pirola,ICumetti D,et al Is the anteroposterior and transverse diameter ratio of nonpalpable thyroid nodules a sonographic criteria for reconm ending fine-needle aspiration cytology[J].Clin Endocrinol,2005,63 (6):689-693
[13]陈文,张武,苗立英,等.甲状腺恶性肿瘤的二维及彩色多普勒超声征象及其临床意义[J]-中国超声医学杂志,2000,16(7)：495-497
[14]Kessler A,Rappaport Y,Blank A.Cystic Appearance of Cervical Lymph Nodes is Characteristis of Metastatic Papillary Thyroid Carcinoma[J]. Journal of Clinical Ultrasound,2003,3121-24
[15]Wada N,Duh Q Y,Sugino K,et al.Lymph Node Metastasis from 259 Papillary Throid Microcarcinomas:Frequency,Patern of Occurrence and Recurrence, and Optimal Strategy for Neck Dissection[J].Ann Surg,2003,237(3):399-407
[16]燕山.浅表淋巴结的超声诊断[J].中国超声医学杂志,2000,16(3)：230-233
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