超声引导下颈淋巴结穿刺联合血清TSH、SIL-2R水平检测与甲状腺癌患者颈部淋巴结转移及疾病严重程度的关系

Relationship between ultrasound-guided cervical lymph node puncture combined with serum TSH and SIL-2R levels in cervical lymph node metastasis and disease severity in patients with thyroid cancer

目的探讨超声引导下颈淋巴结穿刺联合血清促甲状腺激素(thyrotropin,TSH)、可溶性白细胞介素2受体(soluble interleukin-2 receptor,SIL-2R)水平检测与甲状腺癌患者颈部淋巴结转移及疾病严重程度的关系。方法选择甲状腺癌患者120例,根据手术后病理结果分为Ⅰ/Ⅱ期组和Ⅲ/Ⅳ期组以及无转移组和转移组。所有患者均行超声引导下颈淋巴结穿刺检查,并检测血清TSH、SIL-2R水平。结果超声引导下颈淋巴结穿刺检测出106例淋巴结转移,准确率为85.00%(102/120)。超声引导下颈淋巴结穿刺对于Ⅱ期、Ⅲ期、Ⅳ期的淋巴结转移检测的准确率明显高于对于Ⅰ期甲状腺癌淋巴结转移的准确率(P<0.01)。Ⅲ/Ⅳ期组血清TSH和SIL-2R水平明显高于Ⅰ/Ⅱ期组(P<0.01)。甲状腺癌患者血清TSH和SIL-2R水平与病理分期呈正相关(P<0.01)。转移组血清TSH和SIL-2R水平明显高于无转移组(P<0.01)。对于甲状腺癌颈部淋巴结转移,超声穿刺、TSH、SIL-2R平行联合检测的准确度、敏感度、阴性预测值明显高于单项联合检测。结论Ⅲ/Ⅳ期或合并颈部淋巴结转移的甲状腺癌患者具有更高的血清TSH、SIL-2R水平,并且超声引导下颈淋巴结穿刺与血清TSH、SIL-2R联合检测可提高诊断的准确度和敏感度。

Objective To explore the relationship between ultrasound-guided cervical lymph node puncture combined with thyrotropin(TSH)and oluble interleukin-2 receptor(SIL-2R)and cervical lymph node metastasis and disease severity in patients with thyroid cancer.Methods One hundred and twenty patients with thyroid cancer were selected and divided into stageⅠ/Ⅱgroup and stageⅢ/Ⅳgroup,non-metastatic group and metastatic group according to the postoperative pathological results.All patients underwent ultrasound-guided cervical lymph node aspiration and their serum TSH and SIL-2R levels were measured.Results Ultrasound-guided cervical lymph node aspiration detected 106 lymph node metastases with an accuracy rate of 85.00%(102/120).The accuracy of ultrasound-guided cervical lymph node aspiration for stageⅡ,Ⅲ,andⅣlymph node metastasis was significantly higher than that for stage thyroid cancer lymph node metastasis(P<0.01).The levels of serum TSH and SIL-2R in stageⅢ/Ⅳgroup were significantly higher than those in stageⅠ/Ⅱgroup(P<0.01).Serum TSH and SIL-2R levels were positively correlated with pathological stage in patients with thyroid cancer(P<0.01).Serum TSH and SIL-2R levels in the metastatic group were significantly higher than those in the non-metastatic group(P<0.01).For cervical lymph node metastasis of thyroid cancer,the accuracy,sensitivity,and negative predictive value of the combined ultrasound puncture,TSH,and SIL-2R parallel tests were significantly higher than those of the single test.Conclusion Patients with stageⅢ/Ⅳor thyroid cancer with cervical lymph node metastasis have higher serum TSH and SIL-2R levels.Ultrasound-guided cervical lymph node aspiration combined with serum TSH and SIL-2R detection can improve the accuracy and sensitivity of diagnosis.