术前超声联合增强CT对甲状腺乳头状癌中央区淋巴结转移的诊断价值

Diagnostic value of preoperative Ultrasound combined with contrast-enhanced CT in central compartment lymph node metastasis of papillary thyroid carcinoma

目的比较分析术前超声、增强CT、超声联合增强CT三种方法对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)中央区淋巴结转移的诊断效能。方法回顾性分析中山大学肿瘤防治中心头颈外科同一治疗小组完成的339例PTC病例。所有病例均在术前完成甲状腺及颈部淋巴结的超声及增强CT检查,对中央区淋巴结是否转移做出影像学诊断,并与病理进行对照。结果假设以超声和/或CT发现中央区淋巴结做为转移性淋巴结的诊断标准,超声、增强CT、超声+增强CT的敏感度分别为75.62%、91.04%、97.01%,特异度分别为55.07%、55.80%、34.78%,准确度分别为67.26%、76.70%、71.68%。当以US和/或CT的典型的PTC转移性淋巴结特征做为诊断标准时,US、CT、US+CT的敏感度分别为58.21%、74.13%、84.58%,特异度分别为86.23%、77.54%、71.01%,准确度分别为69.62%、75.52%、79.06%。结论超声和CT联合应用可提高PTC中央区转移性淋巴结诊断效能。

OBJECTIVE To compare and analyze the different diagnostic efficacy of preoperative ultrasound,contrast enhanced CT and ultrasound combined with enhanced CT in central compartment lymph node metastasis（CLNM） of papillary thyroid carcinoma（PTC）. METHODS A retrospective analysis of 339 cases was conducted on patients with papillary thyroid carcinoma treated at Sun Yatsen University Cancer Center. All the patients underwent ultrasound and contrast enhanced CT before surgery. The central compartment lymph node status on these two imaging modalities were correlated with the histopathologic results respectively. RESULTS When finding the lymph nodes by ultrasound or CT was used as diagnostic criteria for lymph nodes metastasis by hypothesising, the sensitivity of US, CT and US＋CT were 75.62%, 91.04%, 97.01%; the specificity were 55.07%, 55.80% and 34.78%, and the accuracy were 67.26%, 76.70% and 71.68% respectively. When detecting the typical characteristics of metastatic lymph nodes of PTC by the US and/or CT was considered as the diagnostic standard,the sensitivity of the US, CT and US ＋ CT were 58.21%,74.13%, 84.58%, the specificity were 86.23%, 77.54% and 71.01% respectively, and the accuracy of were 69.62%, 75.52%and 79.06%. CONCLUSION The combined application of US and CT can improve the diagnostic efficiency of central compartment lymph nodes metastasis of PTC.