实时组织弹性成像在鉴别颈部淋巴结核和淋巴结转移中的价值

Value of Real-Time Ultrasound Elastography in Assessment of Cervical Lymphatic Tuberculosis and Lymph Node Metastasis

目的探讨实时组织弹性成像（RTE）技术在鉴别颈部淋巴结核和淋巴结转移中的价值。方法选取2014年4～12月在首都医科大学附属北京胸科医院诊治的121例颈部淋巴结肿大患者，对145个颈部肿大淋巴结行二维超声及弹性成像检查，以超声引导下穿刺活检或外科手术取得组织学病理结果为金标准，构建受试者工作特征（ROC）曲线，计算曲线下面积（AUC），综合评价不同方法对鉴别淋巴结核和淋巴结转移的价值。结果二维超声鉴别两种淋巴结肿大的灵敏度、特异度及准确度分别为61．11％、86．54％、73．58％，AUC为O．763；应变率比值法鉴别两种淋巴结肿大的最佳分界值为2．33，灵敏度、特异度和准确度分别为88．89％、61．54％和75．47％，AUC为0．778；弹性评分法鉴别两种淋巴结肿大的分界值为2．5，灵敏度、特异度和准确度分别为7O．37％、78．85％和74．53％，AUC为0．730，三种方法的ROC曲线有重合，故其曲线面积差异无统计学意义（P〉0．05）。结论RTE在鉴别颈部淋巴结核和淋巴结转移中，较传统超声未见明显优势。

Objective To explore the diagnostic value of real-time tissue elastography （RTE） and conventional ultrasound in the differentiation between tuberculosis and metastatic enlarged cervical lymph nodes .Methods A total of 145 cases of cervical enlarged lymph nodes from 121 patients who were treated in Beijing Chest Hospital Affiliated to Capital Medical University during Apr.2014 and Dec.2014 were included in the study.B-mode ultrasound （B-US） and UE were examined in objective lymph nodes.With ultrasound-guided biopsy or surgical pathologic diagnosis as the golden standard, ROC curves were drawn and area under cures （AUC） was calculated. The value of different methods for differentiation lymph node tuberculosis and metastatic enlarged cervical lymph nodes were comprehensively assessed. Results The sensitivity, specificity and accuracy of the two dimensional ultrasound to identify two types of lymphadenectasis were 61.11%, 86.54%, 73.58%, and AUC was 0.763; cut-off value of strain ratio method to identify two types of lymphadenectasis was 2.33, and the sensitivity, specificity and accuracy were 88.89%, 61.54% and 75.47%, AUC was 0.778; cut- off value of elastic boundary identification of two types of lymphadenectasis was 2.5, and the sensitivity, specificity and accuracy were 70.37%, 78.85% and 74.53% respectively, AUC 0.730,ROC curve of the three methods were overlapped, so there was no statistically significant difference of the area curve. Conclusion Compared with the traditional ultrasonography, RTE has no obvious advantage in the differential diagnosis of cervical lymph node tuberculosis and lymph node metastasis.