分化型甲状腺癌侧颈淋巴结转移的联合诊断

Combined diagnosis for lateral neck lymph node metastasis in differentiated thyroid carcinoma

目的探讨细针穿刺细胞学检查(FNA-C)联合细针穿刺洗脱液甲状腺球蛋白(FNA-Tg)检测在诊断分化型甲状腺癌(DTC)侧颈淋巴结转移中的应用价值。方法回顾性分析行颈部淋巴清扫术治疗的87例DTC患者的临床资料,患者术前超声检查共筛查出124枚可疑淋巴结,其中术后病理检查确诊为转移性淋巴结76枚(转移淋巴结组),非转移性淋巴结48枚(非转移淋巴结组)。所有患者均行FNA-C、FNA-Tg检查。以术后病理检查为金标准,比较FNA-C、FNA-Tg、FNA-C联合FNA-Tg的诊断结果及诊断效能。结果转移淋巴结组FNA-Tg浓度为(232.45±41.32)μg/L,高于非转移淋巴结组的(14.67±3.24)μg/L,差异有统计学意义(P<0.05)。FNA-C联合FNA-Tg诊断的灵敏度为96.05%,准确度为94.29%,阴性预测值为93.62%,均高于FNA-C的76.32%、83.87%、71.88%,差异有统计学意义(P<0.05)。FNA-C联合FNA-Tg诊断的灵敏度高于FNA-Tg,差异有统计学意义(P<0.05)。结论FNA-C联合FNA-Tg检查有助于提高DTC侧颈淋巴结转移诊断效能。

Objective To study application value of fine needle aspiration cytology(FNA-C)combined with thyroglobulin measurement in fine-needle aspiration biopsy(FNA-Tg)in the diagnosis of lateral neck lymph node metastasis in differentiated thyroid carcinoma(DTC).Methods The data of 87 patients with DTC undergoing lymphodissection were analyzed retrospectively.A total of 124 suspicious lymph nodes were detected by preoperative ultrasound examination,among which 76 lymph nodes were confirmed as metastatic lymph nodes(metastatic lymph nodes group)and 48 lymph nodes were confirmed as non-metastatic lymph nodes(non-metastatic lymph nodes group).All patients were examined by FNA-C and FNA-Tg in combination,and the diagnostic results and diagnostic efficacy of FNA-C,FNA-TG and FNA-C combined with FNA-TG were compared using postoperative pathological examination taking as the gold standard.Results The level of FNA-Tg in the metastatic lymph nodes group was(232.45±41.32)μg/L,which was significantly higher than(14.67±3.24)μg/L of non-metastatic lymph nodes group(P<0.05).Diagnostic sensitivity,accuracy and negative predictive value of FNA-C combined with FNA-Tg were 96.05%,94.29%,and 93.62%,which were significantly higher than 76.32%,83.87%,71.88%,respectively by FNA-C(P<0.05).The diagnostic sensitivity of FNA-C combined with FNA-Tg was significantly higher than that by FNA-Tg(P<0.05).Conclusion FNA-C combined with FNA-Tg helps to improve the diagnostic efficiency of DTC lateral neck lymph node metastasis.