术前彩超在诊断甲状腺癌早期颈淋巴转移中的作用

Role of Preoperative Ultrasonography in Evaluating Early Cervical Metastasis in Patients with Differentiated Thyroid Carcinoma

目的评价术前彩超在诊断分化型甲状腺癌早期颈转移中的作用。方法回顾性分析51例(55侧)术前颈部触诊阴性,由彩超检查诊断为甲状腺癌颈转移的患者(研究组)与57例(64侧)术前颈部触诊阳性由查体诊断为甲状腺癌颈转移患者(对照组)的病例资料,2组患者均接受过改良性颈清扫术,比较研究组患者术前彩超检查与术后病理结果。结果彩超诊断颈转移的51例(55侧)患者术后病理49侧为颈转移,彩超检查的灵敏度为89·1%;彩超检查可以发现41·2%的临床触诊漏诊的隐匿性转移。彩超发现65·5%的患者为多分区转移,以中颈最高(70·9%);病理发现75·5%的患者为多分区转移,以Ⅲ区最高(65·3%),彩超与病理检查结果基本相同。结论术前彩超可以提高颈转移的诊断率;可以对转移淋巴结进行定位,为颈清扫的范围提供依据。

Objective To evaluate the role of preoperative ultrasonography in detecting early cervical lymph node metastasis in differentiated thyroid carcinoma. Methods Data were reviewed retrospectively from medical records between July 2003 and July 2005, in which patients were divided into 2 groups： group A （ study group） ： 51 （55 sides） patients of differentiated thyroid carcinoma patients with impalpable node but with ultrasonic positive nodal metastasis; group B （control group） ： 57 （64 sides） patients with preoperative palpable cervical lymph nodes. All patients had been undergone modified neck dissection. The preoperative ultrasonographie results and the preoperative pathologic finding had been compared in group A. Results In 51 patients （55 sides） of preoperative positive ultrasonography 49 sides had been demonstrated cervical lymph nodes metastasis pathologically. The sensitivity of ultrasonography was 89. 1%. Ultrasonography detected cervical lymph node believed to be uninvolved by physical examination in 41.2% of patients. 65.5% of the cervical lymph metastasis was multilevel and the most frequent involvement site was middle neck and the involvement rate was 70. 9% in ultrasonography. 75.5% of the cervical lymph metastasis was multilevel and the most frequent involvement site was level Ⅲ （65.3%） in pathologic finding. Conclusions Preoperative ultrasonograpy is a mainstay in detecting cervical lymph nodes metastasis in thyroid cancer patients. It can detect the early cervical lymph node metastasis and localize the position of the cervical metastasis. All the thyroid cancer patients should undergo preoperative ultrasonography and the extent of the neck dissection relies on the preoperative ultrasonic finding of the neck.