超声联合细针穿刺洗脱液甲状腺球蛋白诊断乳头状甲状腺癌术后淋巴结转移的效能

The diagnostic efficiency of ultrasound combined with FNA-Tg in the diagnosis of lymph node metastasis after surgery for papillary thyroid carcinoma

目的探讨超声检查联合细针穿刺洗脱液甲状腺球蛋白(FNA-Tg)检测对乳头状甲状腺癌(PTC)患者术后颈部淋巴结转移的诊断效能。方法选取120例术后复查出现颈部淋巴结肿大的PTC患者,对所有可疑淋巴结进行超声检查及FNA-Tg检测。以术后病理检查结果为金标准,计算两种方法单独及联合应用鉴别诊断PTC患者术后发生颈部淋巴结转移的灵敏度、特异度、误诊率、漏诊率及约登指数。结果长径/短径﹤2、有钙化灶、淋巴结边界模糊的PTC患者术后淋巴结阳性检出率明显高于长径/短径≥2、无钙化灶、淋巴结边界清晰的患者(P﹤0.01);不同内部回声情况的PTC患者术后淋巴结阳性检出率比较,差异有统计学意义(P﹤0.01)。超声、FNA-Tg、超声联合FNA-Tg鉴别诊断PTC患者术后淋巴结转移的灵敏度分别为72.41%、87.36%、96.55%,特异度分别为85.45%、81.82%、92.73%,漏诊率分别为27.59%、12.64%、3.45%,误诊率分别为14.55%、18.18%、7.27%,约登指数分别为0.58、0.69、0.89。结论超声联合FNA-Tg鉴别诊断PTC患者术后淋巴结转移的效能高于二者单独应用。

Objective To investigate the diagnostic efficiency of ultrasonography combined with thyroglobulin in fine needle aspirate fluid(FNA-Tg)in the diagnosis of cervical lymph node metastasis after surgery for papillary thyroid carcinoma(PTC).Method The study included 120 patients with swollen cervical lymph nodes identified during the postoperative reexamination after surgery for PTC,all suspected lymph nodes were examined by ultrasound and/or FNA-Tg.Surgical pathology results were referenced as gold standard,the sensitivity,specificity,misdiagnosis rate and rate of missed diagnosis,as well as the Youden’s index were calculated for the two approaches used alone or in combination to differentially diagnose the presence of postoperative cervical lymph node metastasis in PTC patients.Result The detection rate of positive lymph nodes after surgery in PTC patients with ratio of long-to short-axis diameter<2,presence of calcification,and unclear lymph node margins were significantly higher than that in those with ratio of long-to short-axis diameter≥2,no calcifications,and clear lymph node margins(P<0.01);besides,the internal echo was also associated with the positive detection rate of lymph nodes in patients with PTC after surgery,and the difference was of statistical significance(P<0.01).The sensitivity of ultrasound alone,FNA-Tg alone,and ultrasound plus FNA-Tg in the differential diagnosis of lymph node metastasis was 72.41%,87.36%,and 96.55%,the specificity was 85.45%,81.82%,and 92.73%,the rate of missed diagnosis was 27.59%,12.64%,and 3.45%,the misdiagnosis rate was 14.55%,18.18%,and 7.27%,additionally,the Youden’s index was 0.58,0.69,and 0.89,respectively.Conclusion The diagnostic efficiency of ultrasound combined with FNA-Tg detection in the differential diagnosis of postoperative lymph node metastasis in PTC patients is undoubtedly higher compared with ultrasound or FNA-Tg alone.