超声联合FNA-Tg检测诊断甲状腺乳头状癌侧颈淋巴结转移的临床价值

Clinical Value of Ultrasound Combined with FNA-Tg in the Diagnosis of Lateral Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma

目的:探讨二维超声及细针穿刺洗脱液甲状腺球蛋白(washout fluid thyroglobulin in fine-needle aspiration,FNA-Tg)检测对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)侧颈淋巴结转移的诊断价值。方法:回顾性分析了189例经病理证实为PTC,且术前对超声可疑侧颈淋巴结进行了FNA-Tg测定的患者。绘制R0C曲线,获取转移性淋巴结超声特征评分、FNA-Tg最佳诊断阈值,比较各检测方法(超声、FNA-Tg和超声+FNA-Tg)的诊断效能。结果:在189例患者术前彩超探查到的214枚可疑淋巴结中,经病理证实136枚为转移性病灶,78枚经病理或随访证实为反应性R0C曲线显示超声特征评分诊断侧颈淋巴结转移的最佳诊断阈值为>2分,FNA-Tg诊断侧颈淋巴结转移的最佳诊断阈值为>36.02 ng/mL。两种方法联合诊断甲状腺乳头状癌侧颈部淋巴结转移的准确率、敏感性较单一诊断方法高,差异有统计学意义(P<0.05),但特异性较单一方法低,差异无统计学意义(P>0.05)。结论:侧颈部淋巴结超声特征评分与FNA-Tg都是诊断转移性淋巴结的重要方法,联合使用可提高术前淋巴结诊断的准确性和敏感性。

Objective:To investigate the effects of two-dimensional ultrasound and fine-needle aspiration cytology coupled with needle-wash thyroglobulin(FNA-Tg)on lateral cervical lymph node metastasis of papillary thyroid carcinoma(PTC).Methods:189 pathologically confirmed PTC patients who underwent preoperative FNA-Tg determination of ultrasound-suspected lateral cervical lymph nodes were retrospectively analyzed.We drew ROC curve,obtained ultrasound scores of metastatic lymph nodes and the best diagnostic threshold of FNA-Tg,and compared the diagnostic efficiency of different diagnostic methods(ultrasound vs FNA-Tg vs ultrasound+FNA-Tg).Results:Among 189 patients,214 suspicious lymph nodes were detected by ultrasound before operation,in which 136 were confirmed as metastasis by pathology,and 78 were confirmed as reactive lymph nodes by pathology or follow-up.KOC curve showed that the best threshold of ultrasound in the di-agnosis of lateral cervical lymph node metastasis was more than 2 points,and the best threshold of FNA-Tg was more than 36.02 ng/mL.Both accuracy and sensitivity of ultrasound+FNA-Tg was higher than that of either ultrasound or FNA-Tg a-lone,and the difference was statistically significant(P<0.05).However,the specificity of the former was lower than that of the latter,and the difference is not statistically significant(P>0.05).Conclusion:Both ultrasound scores of lateral cervical lymph nodes and FNA-Tg are important methods for diagnosing metastatic lymph nodes.This combination can improve the accuracy and sensitivity of preoperative diagnosis of lymph nodes.