甲状腺乳头状癌超声特征与颈部转移性淋巴结之间的关系

Correlation between the ultrasonic features of papillary thyroid carcinoma and the cervical metastatic lymph nodes

目的探讨甲状腺乳头状癌(PTC)患者癌结节的超声声像图多个特征与颈部淋巴结转移之间的关系。方法回顾性分析212例甲状腺乳头状癌患者的临床病理及超声影像学资料,按照手术病理诊断分为无颈部淋巴结转移组(103例)及颈部淋巴结转移组(109例),分析两组患者的年龄、性别及甲状腺癌结节位置、大小、数目、回声、形态、钙化灶类型、有无囊性变、是否侵犯甲状腺被膜、内部血流等癌结节超声特征与颈部淋巴结转移的相关性。结果两组患者在年龄、性别、癌结节分布位置方面均无统计学显著性差异(P>0.01)。PTC患者淋巴结转移组的癌结节最大径大于无淋巴结转移组、癌结节内微钙化及粗大钙化率高于无淋巴结转移组、癌结节内血流达3级者高于无淋巴结转移组、癌结节侵犯甲状腺被膜者高于无淋巴结转移组,这些征象均具有统计学显著性差异(P<0.01)。PTC患者淋巴结转移组的癌结节数量及内部囊性变率较无淋巴结转移组未见统计学显著性差异(P>0.01)。结论综合分析甲状腺乳头状癌结节的多个超声特征,一定程度上或可预测颈部淋巴结转移,为临床上制定首次治疗策略、判断患者预后等方面提供有用依据。

Objective To explore the correlation between the ultrasonic features of papillary thyroid carcinoma(PTC)and the cervical metastatic lymph nodes.Methods A total of 212 patients with PTC confirmed with surgical operation and pathological diagnosis were enrolled and divided into cervical lymph node non-metastasis group(n=103)and cervical lymph node metastasis group(n=109).The ultrasonic features of PTC,including the age and sex in patients with PTC,PTC nodule location,size,numbers,internal echogenicity,shape,patterns of calcification,cystic degeneration,extracapsular extension and the classification with Adler grades of blood flow,were analyzed.Correlation analysis between the parameters and lymph node metastasis was performed using Chi-squared test and Rank-sum test.Results The age,sex in patients with PTC and the location,numbers,cystic degeneration of PTC nodules were not significantly related with cervical lymph node metastasis(all P>0.01).The maximum diameter,punctate echogenic foci,macrocalcifications,Adler gradesⅢof blood flow,extracapsular extension of PTC nodules were significantly related with cervical lymph node metastasis(all P<0.01).Conclusion The comprehensive analysis of multiple ultrasonic features for PTC nodules may predict the incidence of cervical lymph node metastasis in some extent,and provide evidence for primary treatment strategies and prognosis in patients with PTC.