术前超声引导淋巴结细针穿刺检查联合洗脱液甲状腺球蛋白测定对诊断甲状腺乳头状癌侧颈部淋巴结转移的价值

Clinical value of high frequency ultrasound guided FNA and washout fluid thyroglobulin detection for diagnosing lateral neck lymph nodes metastasis of thyroid carcinoma

目的探讨采用超声引导下淋巴结细针穿刺（FNA）细胞学＋洗脱液甲状腺球蛋白测定（FNA—Tg）双重检查法对甲状腺乳头状癌术前侧颈部淋巴结转移的诊断价值。方法选取205例甲状腺细针穿刺细胞学检查证实为甲状腺乳头状癌并且超声发现有可疑侧颈部淋巴结肿大的术前患者，高频超声引导下均行淋巴结FNA和洗脱液FNA—Tg测定．所有淋巴结经手术切除，并送组织病理学检查。结果205例患者中共检出240个淋巴结，病理证实淋巴结转移184个。FNA细胞学检查判定为阳性淋巴结者162个，阴性者78个，诊断侧颈部淋巴结转移的准确性、敏感性、特异性为87．5％、85．0％、92．8％；洗脱液FNA—Tg检测判定阳性淋巴结168个，阴性淋巴结72个，诊断侧颈部淋巴结转移的准确性、敏感性、特异性为90．0％、89．1％、92．9％；两种方法联合（FNA＋FNA—Tg）判定阳性淋巴结172个，阴性淋巴结68个，诊断侧颈部淋巴结转移的准确性、敏感性、特异性为95．O％、93．5％、100％。FNA＋FNA—Tg联合诊断甲状腺乳头状癌侧颈部淋巴结转移的准确率较单一诊断方法高，差异有统计学意义（z。=8．454，P=0．004；Y。=4．324，P=0．038）。结论FNA细胞学检查与洗脱液FNA—Tg浓度检测联合使用可提高诊断准确率。

Objective To investigate the diagnositc value of high frequency ultrasound guided fine needle aspirates （FNA） combined with washout fluid thyroglobulin （FNA-Tg） measurement for preoperative detecting lateral neck lymph node metastasis of thyroid carcinoma. Methods 205 preoperative patients with suspected metastatic lymph nodes were collected. All the patients were diagnoed as papillary thyroid cancer by FNA. They all underwent high frequency ultrasound guided fine-needle aspiration cytdogy, then Tg in FNA washout fluid （FNA-Tg） was measured. The histopathologie diagnosis for all of the suspected lymph nodes was obtained after lymphadenectomy. Results Of the 240 suspected lymph nodes 184 lymph nodes were positive by pathology, while 56 were negative. While 162 lymph nodes were diagnosed as positive metastasis and 78 as negative metastasis by FNA. The accuracy, sensitivity, specificity of FNA for assessing cervical metastatic lymph nodes were 87.5% , 85.0% , 92.8% , respectively. By FNA-Tg, 168 lymph nodes were diagnosed as positive and 72 as negative metastasis. The accuracy, sensitivity, specificity of FNA-Tg for assessing cervical metastatic lymph nodes were 90. 0% , 89. 1% , 92.9% , respectively. Two-method combined,172 lymph nodes were diagnosed as positive metastasis and 68 as negative. The accuracy,sensitivity, specificity of FNA ＋ FNA-Tg for assessing lateral neck metastatic lymph nodes were 95.0% , 93.5% , 100% , respectively. The accuracy rate of the the combined were higher than that of single diagnosis （X2 = 8.454,P = 0. 004;X2 = 4. 324, P = 0. 038）. Conclusions FNA and FNA-Tg combined are more sensitive and accurate in predicting lateral neck metastatic lymph nodes in preoperative PTC patients.