分化型甲状腺癌颈部转移性淋巴结FNA-Tg测定结合超声风险特征参数诊断效能的研究

Study on the diagnostic efficacy of FNA-Tg measurement combined with ultrasonic risk characteristic parameters in differentiated thyroid carcinoma with cervical metastatic lymph nodes

目的:探讨高频超声引导下分化型甲状腺癌(DTC)颈部转移性淋巴结细针抽吸洗脱液-甲状腺球蛋白(FNA-Tg)水平联合超声风险特征参数的诊断效能。方法:选取92例DTC患者102枚颈部淋巴结为研究对象,按淋巴结是否发生转移分为转移性淋巴结组(MLN组,n=72)和非转移性淋巴结组(NMLN组,n=30)。分析FNA-Tg水平联合超声风险特征参数的诊断效能。结果:超声检测淋巴结呈现团状高回声、伴微钙化、伴囊性变、颈部淋巴结可疑转移组数≥2组、血流呈杂乱混合灌注、RI、S、L/S被认定为超声风险特征参数,单参数诊断的敏感性(SE)为67.4%~90.2%,特异性(SP)为62.5%~85.2%,≥3个超声风险特征多参数诊断SE 96.1%~100%,SP 90.7%~98.2%,FNA-Tg单参数诊断SE 83.3%,SP 74.2%。FNA-Tg结合1~2个颈部淋巴结超声风险特征进行联合诊断,诊断SE 94.2%和96.5%,SP 86.4%和95.6%。结论:超声风险特征只显示1~2个异常变化时,FNA-Tg阳性结合超声风险特征进行联合诊断能克服单一参数和单一技术的不足,提高DTC颈部转移性淋巴结的检出。

Objective:To investigate the diagnostic efficacy of high frequency ultrasound-guided fine-needle lymph node aspiration for thyroglobulin measurement(FNA-Tg)combined with ultrasound risk characteristic parameters in differentiated thyroid carcinoma(DTC)with cervical metastatic lymph nodes.Methods:102 cervical lymph nodes from 92 patients with DTC were selected as the research objects.According to whether the lymph nodes had metastasis,they were divided into metastatic lymph node group(MLN group,n=72)and non metastatic lymph node group(NMLN group,n=30).The diagnostic efficacy of FNA-Tg level combined with ultrasonic risk characteristic parameters was analyzed.Results:Ultrasonic detection of lymph nodes with mass hyperecho,microcalcification,cystic change,number of suspected metastasis groups of cervical lymph nodes≥2 groups,chaotic mixed perfusion of blood flow,RI,S and L/s were identified as ultrasonic risk characteristic parameters.The sensitivity(SE)and specificity(SP)of single parameter diagnosis were 67.4%~90.2%and 62.5%~85.2%,respectively.Multi parameter diagnosis of≥3 ultrasonic risk characteristics SE 96.1%~100%,SP 90.7%~98.2%,and diagnostic SE and SP of FNA-Tg was 83.3%and SP 74.2%by using single ultrasound parameter.FNA-Tg combined with 1~2 cervical lymph node ultrasonic risk characteristic parameters,SE were 94.2%and 96.5%,SP were 86.4%and 95.6%.Conclusion:When ultrasonic risk characteristic parameters only showed 1~2 abnormal changes,FNA-Tg positive combined with ultrasonic risk characteristic parameters diagnosis method can overcome the shortcomings of single parameter and single technology and improve the detection of DTC cervical metastatic lymph nodes.