高频彩超对甲状腺癌颈部淋巴结转移的诊断价值

DIAGNOSTIC VALUE OF COLOR DOPPLER ULTRASOUND IN METASTATIC CERVICAL LYMPH NODES OF THYROID CARCINOMA

目的了解甲状腺癌颈部淋巴结转移的主要超声表现及少见的灶性转移特点。方法收集经手术病理证实的甲状腺癌颈部淋巴结转移病人51例的术前超声检查资料，按颈部淋巴结分区记录淋巴结的位置及超声表现。结果51例病人经病理证实有转移性淋巴结298枚，反应增生性淋巴结189枚。转移性淋巴结以Ⅲ、Ⅳ、Ⅱ区分布为主，转移率分别为71．0％、54．8％、51．6％；73．8％纵横比〈2，89．2％门部高回声消失，36．6％内部见点状高回声（胶体析出或微钙化），15．4％示囊性变，44．3％显示周边型血流信号，3．7％呈灶性转移。反应增生性淋巴结纵横比〈2、门部高回声消失、内部见点状高回声、囊性变、周边型血流信号的出现率分别为22．6％、12．1％、0、0、0。转移性淋巴结组与反应增生性淋巴结组的上述超声指标差异有统计学意义（χ2=29．152～284．884，P〈0．05）。结论甲状腺癌颈部淋巴结超声表现及位置有助于鉴别是转移性淋巴结还是反应增生性淋巴结。

Objective To study the major ultrasonographic manifestations of metastatic cervical lymph nodes （MCLN） in thyroid carcinoma. Methods Preoperative ultrasonographic data of 51 thyroid cancer patients with MCLN confirmed by surgery and pathology were collected. The sonographic manifestations and locations of the lymph nodes were recorded. Results A total number of the metastatic lymph nodes were 298 and reactive hyperplasia 189. The metastatic lymph nodes mainly located in regions Ⅲ（71.0%）, Ⅳ （54.8%） and Ⅱ （51.6%）, respectively. The sonographie manifestations of the lymph nodes included long/short axis less than 2 in 73.8%, absence of an echogenic hilum in 89.2%, hyperechoic punctuations in 36.6%, cystis degeneration in 15. 4%, peripheral vascularization in 44. 3% and nodal tumor in 3.7%. The manifestations of the reactive hyperplasia lymph nodes of the five items as seen in the metastatic were observed in 22.6%, 12.1%, 0,0, and 0, respectively, the differences between the the two groups were significant （χ2= =29. 152 284. 884,P〈0.05）. Conclusion The ultrasonographic manifestations and locations of cervical lymph nodes in patients with thyroid carcinoma is conducive to the differential diagnosis of the lymph nodes.