超声特征在甲状腺乳头状癌颈侧区淋巴结转移中的诊断价值

Diagnostic value of ultrasound features in neck lateral lymph node metastasis of papillary thyroid carcinoma

目的探讨超声特征在甲状腺乳头状癌(PTC)颈侧区淋巴结转移中的诊断价值。方法回顾性分析2016年9月至2018年2月在郑州大学第一附属医院接受PTC颈侧区淋巴结清扫的250例患者(286个淋巴结)的术前超声资料,以术后常规病理结果为诊断金标准,将患者分为转移组和未转移组,分析其超声特征及诊断准确性。结果 250例患者中,221例(88.4%)为癌转移,29例(11.6%)未见转移;286个可疑颈侧区淋巴结中,术后常规病理结果证实252个(88.1%)为淋巴结癌转移,34个(11.9%)未见转移。年龄、淋巴门是否缺失、有无囊性变、CDFI血流信号情况与PTC颈侧区淋巴结转移有关(P<0.05)。囊性变、淋巴门缺失、外周型血流信号和混合型血流信号是PTC颈侧区淋巴结转移的独立危险因素(P<0.05)。囊性变、淋巴门缺失、血流信号ROC曲线下面积(AUC)分别为0.669、0.688、0.751,联合AUC为0.837(95%CI:0.759～0.915)。结论术前超声检查诊断PTC颈侧区淋巴结转移灵敏度较高,对手术方案的制定有一定的指导作用。

Objective To explore the diagnostic value of ultrasound features in neck lateral lymph node metastasis of papillary thyroid carcinoma (PTC). Methods The preoperative ultrasonographic data of 250 patients (286 lymph nodes) who accepted neck lateral lymph node dissection in the First Affiliated Hospital of Zhengzhou University from September 2016 to February 2018 were analyzed retrospectively. Routine pathological results after operation were regarded as the gold standard for diagnosis. The patients were divided into metastasis group and non-metastasis group. The ultrasound features and diagnostic accuracy were analyzed. Results Among 250 patients, 221 cases (88.4%) were cancer metastasis and 29 cases (11.6%) had no metastasis. Among 286 suspicious neck lateral lymph nodes, the routine pathological results confirmed that 252 cases (88.1%) were lymph node cancer metastasis and 34 cases (11.9%) had no metastasis. The age, lack of lymphatic hilum or not, cystic degeneration or not and CDFI blood flow signals were related to neck lateral lymph node metastasis of PTC ( P < 0.05). The cystic degeneration, lack of lymphatic hilum, peripheral and mixed blood flow signals were independent risk factors for neck lateral lymph node metastasis of PTC ( P < 0.05). The area under curve (AUC) of ROC of cystic degeneration, lack of lymphatic hilum and blood flow signal were 0.669, 0.688 and 0.751, respectively. The combined AUC was 0.837 (95% CI : 0.759 to 0.915). Conclusion Preoperative ultrasonography has high sensitivity in the diagnosis of neck lateral lymph node metastasis of PTC. It has a certain guiding role in the formulation of surgical plans.