颈部超声、甲状腺球蛋白诊断复发分化型甲状腺癌

Cervical ultrasound and thyroglobulin in diagnosis of recurrence of differentiated thyroid carcinoma

背景与目的:颈部超声与血清甲状腺球蛋白(thyroglobulin,Tg)是分化型甲状腺癌(differentiated thyroid carcinoma,DTC)术后随访的主要方法。刺激性Tg对分化型甲状腺癌的诊断价值已被充分证实,但抑制性Tg对DTC复发转移的诊断价值鲜有报道。该研究分析颈部超声及抑制性Tg对DTC复发转移的诊断价值。方法:回顾性分析2010年8月—2014年12月在北京协和医院行2次或以上手术,临床怀疑复发的DTC患者196例。选择其中入院前行甲状腺全切术后和(或)^(131)I清甲治疗术后超声怀疑复发转移的患者共62例。分析转移性淋巴结超声特征以及抑制性Tg对DTC复发转移的诊断价值。结果:经病理证实,62例患者中59例为淋巴结转移,1例为局部复发,2例术后未发现明确复发转移。超声发现可疑淋巴结共121个,经病理证实转移性淋巴结92个,非转移性淋巴结25个,纤维组织3个,横纹肌组织1个。淋巴结内无回声、高回声及强回声对转移性淋巴结的阳性预测值均为100%,皮质内无回声及血流信号杂乱在转移性淋巴结和非转移淋巴结中差异有统计学意义。抑制性Tg阳性者(Tg≥0.2 ng/m L)49例,阴性者(Tg<0.2 ng/m L)13例,抑制性Tg诊断颈部复发转移的准确率为82.3%,灵敏度为81.7%,特异度为100%。结论:皮质内无回声及血流信号杂乱是鉴别复发DTC颈部转移性淋巴结与非转移性淋巴结特异度较高的指标,抑制性Tg(Tg≥0.2 ng/m L)对DTC的复发转移有较高的诊断价值,颈部超声检查可发现血清Tg为阴性患者的复发转移病灶。

Background and purpose： This study investigated the value of cervical ultrasound and TSH-sup- pressed thyroglobulin in the diagnosis of recurrence or metastasis of differentiated thyroid carcinoma （DTC）. Methods： This study analyzed the data on 196 thyroid carcinoma patients who underwent neck dissection after clinically sus- pecious recurrence of DTC in Peking Union Medical College Hospital from Aug. 2010 to Dec. 2014. Among the 196 patients, 62 patients sonographically suspecious recurrence after total thyroidectomy and/or radioactive iodine ablation therapy were enrolled in this study. The ultrasonic features of lymph node involvement were retrospectively analyzed, The value of the ultrasonic features in the diagnosis of lymph node involvement and a TSH-suppressed serum Tg level in the diagnosis of recurrence or metastasis of DTC was also evaluated. Results： Of the 62 patients, 59 were pathologi- cally confirmed with lymph node involvement, 1 case with local recurrence and 2 cases without recurrence or metasta-sis. There were 121 ultrasonographically suspected lymph nodes, confirmed by pathology, 92 were metastatic ltsions, 25 were non-metastatic, 3 were fibrous tissue and 1 was striated muscle. The positive predictive rate of cyst, calcification or hyper-echogenicity in cortex was 100% in the diagnosis of lymph node involvement. There was a significant difference in disordered vascularity and cyst in cortex between metastatic and non-metastatic lymph nodes. Forty-nine patients were positive for Tg, whereas 13 were negative. The accuracy, sensitivity and specificity of TSH-suppressed serum Tg in the diagnosis of recurrence or metastasis of DTC were 82.3%, 81.7% and 100%. Conclusion： The disordered vascularity and cyst in cortex of the lymph node are highly specific indexes in diagnosing lymph node involvement. TSH-suppressed serum Tg level has high diagnostic value for detection of recurrence or metastasis of DTC. Cervical ultrasound can identify recurrent or metastatic lesions in both Tg-positive and Tg-negative patients.