超声在甲状腺乳头状癌术前分期中的应用价值

Performance of ultrasonography for the preoperative staging of papillary thyroid carcinoma

目的探讨超声在甲状腺乳头状癌术前分期中的应用价值。方法收集2014年1至11月中国医学科学院肿瘤医院经术后病理学检查证实的甲状腺乳头状癌患者121例，共169个病灶。分析肿瘤大小、甲状腺被膜外侵犯范围及颈部淋巴结转移等超声表现，根据国际抗癌联盟（UICC）（第6版）甲状腺癌分期标准行术前分期，并与病理分期对照，评估超声在甲状腺乳头状癌术前分期中的应用价值。结果超声评估甲状腺被膜侵犯的敏感度、特异度、阳性预测值和阴性预测值分别为89．6％（60／67）、72．2％（39／54）、80．O％（60／75）、84．8％（39／46）。术前超声诊断T1～T4正确率分别为75．O％（36／48）、100％（1／1）、81．9％（59，72）、0。超声诊断颈部淋巴结转移的敏感度、特异度、阳性预测值和阴性预测值分别为47．5％（29／61）、90．O％（54／60）、82．9％（29／35）、62．8％（54／86）。结论超声在甲状腺乳头状癌术前分期方面具有较高的应用价值，且有助于判断肿瘤甲状腺外侵犯范围及颈侧部淋巴结转移。

Objective To evaluate the performance of ultrasonography （US） for the preoperative staging of papillary thyroid carcinoma （PTC）. Methods One hundred and twenty-one patients with cytologically proven PTC were prospectively collected. Patients were recruited at the Chinese Academy of Medical Sciences Cancer Hospital from January 2014 to November 2014. Preoperative US was performed for the evaluation of primary tumor size, extrathyroidal extension and neck lymph node metastasis according to the 6th UICC TNM staging system. Results The sensitivity, specificity, positive predictive value （PPV） and negative predicative value （NPV） of US in predicting extrathyroidal extension were 89.6% （60/67）, 72.2% （39/54）, 80.0% （60/75）, 84.8% （39/46）, respectively. The accuracies of preoperative US for T1, T2, T3, T4 stage were 75.0% （36/48）, 100% （1/1）, 81.9% （59/72）, 0, respectively. The sensitivity, specificity, PPV, and NPV of US in predicting neck lymph node metastasis were 47.5% （29/61）, 90.0% （54/60）, 82.9% （29/35）, 62.8% （54/86）, respectively. Conclusion Ultrasonography is a feasible tool for preoperative staging of PTC and is helpful for accurate prediction of extrathyroidal tumor extension and lateral neck lymph node metastasis.