超声引导下细针穿刺细胞学检查联合FNA-Tg测定评估甲状腺乳头状癌颈部转移性淋巴结的价值研究

Value of fine needle aspiration cytology combined with fine needle aspiration thyroglobulin measurements in evaluation of metastatic lymph nodes in patients with papillary thyroid carcinoma

目的探讨超声引导下细针穿刺细胞学检查(US-FNA)联合细针穿刺洗脱液中甲状腺球蛋白(FNA-Tg)测定在评估甲状腺乳头状癌颈部转移性淋巴结中的价值。方法将我院136例甲状腺乳头状癌患者(153个淋巴结)根据病理结果分为转移组66例(74个淋巴结)和无转移组70例(79个)。比较两组FNA-Tg>1.0 ng/ml淋巴结所占比例,以及US-FNA、FNA-Tg及二者联合法诊断转移性淋巴结的敏感性、特异性和准确率;分析并比较符合1、2、3、≥4个可疑转移性淋巴结超声征象时,US-FNA或联合法诊断转移淋巴结的敏感性、特异性及准确率。结果转移组FNA-Tg>1.0 ng/ml的淋巴结比例明显高于非转移组,差异有统计学意义(χ2=85.416,P=0.000)。联合法、FNA-Tg诊断转移性淋巴结敏感性高于单独使用US-FNA,差异均有统计学意义(均P<0.05);联合法诊断转移性淋巴结的特异性高于US-FNA和FNA-Tg,准确率高于US-FNA,差异均有统计学意义(均P<0.05),但与FNA-Tg之间的准确率比较,以及US-FNA与FNA-Tg之间的特异性和准确率比较差异均无统计学意义。当符合1个、2个超声征象时,联合法诊断转移性淋巴结的敏感性(80.0%、90.0%)、准确率(88.0%、92.9%)均高于US-FNA(敏感性:46.0%、60.0%;准确率:74.0%、76.2%),差异均有统计学意义(均P<0.05),但特异性比较差异无统计学意义;当符合3个超声征象时,采用US-FNA或联合法诊断淋巴结是否转移的敏感性、特异性及准确率比较差异均无统计学意义;当符合≥4个超声征象时,采用US-FNA或联合法诊断转移淋巴结的敏感性、特异性及准确率均为100%。结论 US-FNA联合FNA-Tg测定可以提高具有1个或2个可疑淋巴结超声征象的甲状腺乳头状癌患者颈部转移性淋巴结的诊断准确率。

Objective To investigate the value of fine needle aspiration cytology combined with fine needle aspiration thyroglobulin measurements（FNA-Tg）in evaluation of metastatic lymph nodes in patients with papillary thyroid. Methods The clinical data of 136 patients（153 lymph nodes）with papillary thyroid carcinoma were enrolled.According to pathological results,they were divided into the metastasis group 66 cases（74 lymph nodes）and the non-metastasis group 70 cases（79 lymph nodes）.When FNA-Tg1.0 ng/ml or≤1.0 ng/ml,whether a difference between the two groups with or without lymph node metastasis were analyzed.The sensitivity,specificity and accuracy of US-FNA,FNA-Tg,and combined methods in the diagnosis of metastatic lymph nodes were compared.Compared with 1,2,3,≥4 suspicious metastatic lymph node ultrasonic signs,the sensitivity,specificity and accuracy of metastatic lymph nodes by US-FNA or combined method were analyzed.Results The ratio of lymph nodes with FNA-Tg1.0 ng/ml in the metastasis group was significantly higher than that in the non-metastasis group（χ2=85.416,P=0.000）.The sensitivity of the combination method and FNA-Tg was higher than that of US-FNA alone to determine metastatic lymph nodes（P〈0.05）.The specificity of the combined method was higher than that of US-FNA or FNA-Tg.The accuracy of the combined method was higher than that of US-FNA（P〈0.05）,but there was no significant difference of FNA-Tg.The specificity and accuracy of US-FNA and FNA-Tg were not statistically significant.When there was 1 or 2 ultrasound signs,the sensitivity of combined method（80.0%,90.0%）and accuracy（88.0%,92.9%）in the diagnosis of metastatic lymph nodes were significantly higher than those of US-FNA（sensitivity were 46.0%,60.0%,accuracy were 74.0%,76.2%）,there were significant difference（all P〈0.05）,but there was no significant difference of specificity.When there were 3 signs of ultrasound,there was no significant difference in the sensitivity,specificity and accuracy of US-FNA or combined method to determine whether lymph nodes were metastatic.When there were 4 signs of ultrasound,the sensitivity,specificity and accuracy were 100% of US-FNA or combined method to determine whether lymph nodes were metastatic.Conclusion For patients with papillary thyroid carcinoma with 1 or 2 suspicious metastatic lymph node ultrasonic signs,combined US-FNA and FNA-Tg can improve the diagnostic accuracy and are worthy of proper use in clinical practice.