实时超声弹性成像诊断肺癌颈部淋巴结转移及指导穿刺针吸的价值

Value of real-time elastography in the diagnosis of cervical lymph node metastasis of lung cancer and guidance of needle aspiration

目的探讨实时超声弹性成像(RTE)诊断肺癌颈部淋巴结转移及指导穿刺针吸中的价值。方法选取经我院确诊的因颈部淋巴结肿大高度怀疑转移的肺癌患者140例(肿大淋巴结140个),根据细胞学取样法分为二维超声组和RTE组,每组各70例;另选同期健康志愿者36例(淋巴结70个)为正常对照组。RTE组和正常对照组均行二维超声及RTE检查,二维超声组和RTE组分别行二维超声引导下穿刺及RTE引导下穿刺;比较两组穿刺取样成功率、准确率;绘制受试者工作特征(ROC)曲线分析以不同组织为参照的弹性应变率比值(SR1、SR2)、弹性面积比(AR)对肺癌颈部淋巴结转移的诊断效能。结果二维超声组和RTE组穿刺取样成功率比较差异无统计学意义(100%vs.94.29%,P=0.120),穿刺取样准确率分别为81.43%和98.57%,差异有统计学意义(P<0.05)。正常对照组和RTE组的SR1、SR2、AR分别为1.02±0.47、0.98±0.42、0.82±0.09和2.25±0.81、1.63±0.73、1.08±0.11,差异均有统计学意义(均P<0.05)。ROC曲线分析结果显示,SR1、SR2、AR诊断肺癌颈部淋巴结转移的ROC曲线下面积分别为0.926、0.784、0.972;当AR截断值为0.920时,诊断准确率、敏感性、特异性分别为95.7%、97.1%、94.3%,均高于SR1和SR2的诊断效能,差异均有统计学意义(均P<0.05)。结论SR1、SR2、AR在肺癌颈部淋巴结转移诊断中均有一定价值,其中AR诊断价值最高;RTE指导穿刺针吸可提高取样准确率。

Objective To explore the value of real-time elastography(RTE)in the diagnosis of cervical lymph node metastasis of lung cancer and guidance of needle aspiration.Methods A total of 140 lung cancer patients(140 enlarged lymph nodes)diagnosed in our hospital who were highly suspected of metastasis due to cervical lymph node enlargement were selected,and divided into two-dimensional ultrasound group and RTE group according to the cytological sampling method,with 70 cases in each group.Thirty-six healthy volunteers(70 lymph nodes)in the same period were selected as the normal control group,twodimensional ultrasound and RTE were performed in the RTE group and the normal control group,two-dimensional ultrasoundguided puncture and RTE-guided puncture were performed in the two-dimensional ultrasound group and RTE group,respectively.The success rate and accuracy rate of puncture sampling between the two-dimensional ultrasound group and the RTE group were compared.ROC curve was drawn to analyze the diagnostic efficacy of elastic strain rate ratio(SR1,SR2)and elastic area ratio(AR)for cervical lymph node metastasis of lung cancer based on different tissues.Results There was no significant difference in the success rate of puncture sampling between the two-dimensional ultrasound group and the RTE group(100%vs.94.29%,P=0.120).The accuracy rates of puncture sampling in the two-dimensional ultrasound group and RTE group were 81.43%and 98.57%,respectively,and the difference was statistically significant(P<0.05).The SR1,SR2 and AR of the normal control group and RTE group were 1.02±0.47,0.98±0.42,0.82±0.09,and 2.25±0.81,1.63±0.73,1.08±0.11,respectively,and the differences were statistically significant(all P<0.05).ROC curve analysis showed that the area under the curve of SR1,SR2 and AR for diagnosing cervical lymph node metastasis of lung cancer were 0.926,0.784,0.972,respectively.When the AR cut-off value was 0.920,the diagnostic accuracy,sensitivity and specificity were 95.7%,97.1%,and 94.3%,respectively,which were higher than the diagnostic efficiency of SR1 and SR2,the differences were statistically significant(all P<0.05).Conclusion SR1,SR2 and AR have certain value in the diagnosis of cervical lymph node metastasis of lung cancer,and AR has the highest diagnostic value.RTE can improve the sampling accuracy of needle aspiration.