术前超声漏诊甲状腺癌颈部淋巴结转移的原因分析

Causes of missed diangosis of cervical lymphnode metastasis in thyroid carcinoma by preoperative ultrasonography

目的 :分析术前超声漏诊甲状腺癌颈部淋巴结转移的原因,提高术前超声诊断准确率。方法 :回顾性分析170例术前超声漏诊经病理证实为甲状腺癌淋巴结转移患者(漏诊组)及120例超声正确提示甲状腺癌淋巴结转移患者(正确诊断组)的临床资料,分析2组的声像图特征,对其漏诊原因进行归纳总结。结果:经术后病理诊断,术前超声诊断甲状腺癌颈部淋巴结转移漏诊率为58.62%(170/290),其中中央区146例,颈侧区4例,同时累及中央区及颈侧区20例。170例主要表现为:低回声153例(90.00%),边缘不规整117例(68.82%),纵横比>1 59例(34.71%),钙化132例(77.65%),内部结构为实性153例(90.00%),结节累及被膜85例(50.00%)。正确诊断组结节:低回声106例(88.33%),边缘不规整105例(87.50%),纵横比>1 35例(29.17%),钙化113例(94.16%),内部结构为实性115例(95.8%),结节累及被膜88例(73.33%)。在边缘、钙化、累及被膜等方面,2组差异均有统计学意义(均P<0.05)。结论:超声检查在甲状腺癌颈部淋巴结转移诊断方面漏诊率较高,若结节超声表现为低回声、钙化、累及包膜及边缘不规整等特征时,颈部转移淋巴结易漏诊,因此,了解其超声特征,可提高甲状腺癌颈部淋巴结转移的诊断准确率。

Objective：To analyze the causes of missed diangosis of cervical lymphnode metastasis in thyroid carcinoma by pre-operative ultrasonography,and to improve the accuracy of preoperative ultrasound. Methods：Retrospectively analyzed the clinical data of 170 cases with preoperative missed thyroid cancer lymphnode metastasis confirmed by pathology（misdiagnosed group）,and 120 cases with ultrasound correctly prompted thyroid cancer lymphnode metastasis（correct diagnosis group）,analyzed ultrasonographic features of missed diagnosis and correct diagnosis of patients,summarized the reasons for their misdiagnosis. Results：The missed diagnosis of cervical lymphnode metastasis was 58.62%（170/290） by postoperative pathological diagnosis and preoperative ultrasonography. There were 146 cases（146/290） in central area and 4 cases（4/290）,involving the central and cervical side of 20 cases（20/290）. 170 cases of thyroid nodules mainly showed：153 cases of low echo（90%）,irregular margins in 117 cases（68.82%）,aspect ratio 1 in 59 cases（34.71%）,132 cases of calcification（77.65%）. 153 cases had solid internal structure（90%）,85 cases had membrane involvement（50%）. In the edge,calcification,involving the film,etc.,ultrasound missed diagnosis group and the correct diagnosis group were significantly different（P〈0.05）. Conclusion：In the diagnosis of cervical lymphnode metastasis of thyroid carcinoma,ultrasonography is found to have a high missed rate. If thyroid nodules are hypoechoic,calcified,cumulative and irregular,the cervical metastases lymphnodes are very prone to be misdiagnosed. Therefore,the understanding of these ultrasound features is conducive to improving the diagnostic accuracy of cervical lymphnode metastases in thyroid cancer.