甲状腺乳头状癌转移性淋巴结的灰阶超声特征评估

Evaluation of gray-scale sonographic features in metastatic lymph nodes of thyroid carcinoma

目的:探讨甲状腺乳头状癌转移性淋巴结的特征性灰阶超声表现及其临床应用价值。方法 :回顾分析512例甲状腺乳头状癌患者,共发现483个淋巴结,采用灰阶超声评估其淋巴结的分区、形态、边界、淋巴门及内部回声。结果:①病理证实为转移性淋巴结217个,非转移性淋巴结266个;淋巴结转移率为31.3%。②217个转移性淋巴结经灰阶超声检查显示,143个淋巴结的最大径>10 mm,163个淋巴结纵横比(A/T)≤2,62个淋巴结边界不清;大部分淋巴门消失,其余偏心或狭窄;淋巴结内见微钙化的有56个,囊性变的有22个,内部高回声55个。③灰阶超声综合评价转移性淋巴结的灵敏度为65.0%,特异度为92.9%,微钙化、囊性变、高回声评估转移性淋巴结的灵敏度分别为25.8%、10.1%和25.3%,特异度分别为98.1%、99.2%和98.5%。④颈侧区与中央区淋巴结间的超声特征中微钙化、囊性变及高回声差异均有统计学意义。结论:微钙化、囊性变、高回声作为甲状腺乳头状癌转移性淋巴结评估指标具有很高的特异性,颈侧区与中央区的转移性淋巴结灰阶超声特征间存在差异。

Objective To investigate the gray-scale sonographic features of metastatic lymph nodes of papillary thyroid carcinoma （PTC）. Methods Four hundred and eighty-three lymph nodes of 512 patients with PTC were submitted for analysis of gray-scale ultrasound. Sonographic features including location, shape, boundary, hilum, and internal echo were recorded. Internal echo was characterized by microcalcification, cystic change and hyperecho. Results （1）266 lymph nodes were confirmed pathologically as non-metastatic and 217 as metastatic. Metastatic rate was 31.3 %. （2） Gray-scale sonographic features： 143 metastatic lymph nodes were more than 10 mm in maximum diameter, 163 A / T were not more than 2, and 155 were clear in boundary; most had no hilum, while others having deviation or narrow. Microcalcification was found in 56 , cystic change was seen in 22, and hyperecho was found in 56. （3） Sensitivity and specificity for metastatic lymph nodes evaluated by gray-scale sonographic features compositely were 65.0% and 92.9%, respectively. Sensitivity evaluated by microcalcification, cystic degeneration and hyperecho were 25.8%, 10.1% and 25.5%, while specificity were 98.1%, 99.2% and 98.5%, respectively. （4）The sonographic characteristics of microcalcification, cystic change and echo between lateral and central lymph nodes were different. Conclusions The gray-scale sonographic features of metastatic lymph nodes in PTC including micro-calcification, cystic change and hyperecho are highly specific, and are different between lateral and central lymph nodes.