高频彩色多谱勒超声在甲状腺癌颈部淋巴结转移中的诊断价值

Diagnostic Value of High-Frequency Color Doppler Ultrasound in Cervical Lymph Node Metastasis of Thyroid Carcinoma

目的探讨高频彩色多谱勒超声(color Doppler ultrasound,CDU)在甲状腺癌(thyroid carcinoma,TC)颈部淋巴结转移中的诊断价值。方法以海南省第三人民医院2015-2019年85例TC患者为研究对象,采用CDU对其进行检查,并分析其影像特征,及评估CDU在甲状腺癌颈部淋巴结转移中的诊断价值。结果85例TC患者包括乳头状癌79例、鳞癌1例、滤泡状癌3例、髓样癌2例。病理确诊TC外淋巴结肿块共215个,其中121个为转移性TC,94个为淋巴结反应性增生。高频CDU诊断敏感度为73.5%,特异性为80.0%,阳性预测值为85.6%,阴性预测值为71.2%。转移性淋巴结CDU图像显示其囊性变(15.7%)、点状高回声(34.7%)、周边型血流(40.5%)、门部高回声消失(80.2%)存在率明显高于反应增生性淋巴结(分别为0.0%、0.0%、0.0%、11.7%,均P<0.05)。转移性淋巴结血流丰富程度明显高于反应增生性淋巴结(P<0.05)。转移性淋巴结动脉收缩期峰值血流速度(peak systolic velocity,PSV)(35.72±6.63 cm/s)、血流阻力指数(resistance index,RI)(0.77±0.08)明显高于反应增生性淋巴结(24.15±8.27 cm/s,0.61±0.09,P<0.05),而二者脉搏动指数(pulsatility index,PI)值无明显差异(P>0.05)。淋巴结主要转移为Ⅵ区,其次为Ⅲ区、Ⅳ区。结论高频CDU能够分辨TC颈部淋巴结转移的特征,具有较高诊断价值。

Objective To investigate the diagnostic value of high-frequency color Doppler ultrasound(CDU)in cervical lymph node metastasis of thyroid carcinoma(TC).Methods Eighty-five patients with TC in The Third People’s Hospital of Hainan Province from 2015 to 2019 were enrolled in the study.Color Doppler ultrasonography was used to examine the imaging features and estimate the diagnostic value of CDU in cervical lymph node metastasis of thyroid cancer.Results There were 79 papillary carcinomas,1 squamous cell carcinomas,3 follicular carcinomas and 2 medullary carcinomas among the 85 TC patients.Pathologically confirmed TC external lymph node masses were 215,of which 121 were metastatic TC and 94 were reactive hyperplasia lymph node.The diagnostic sensitivity of high-frequency CDU was 73.5%,the specificity was 80.0%,the positive predictive value was 85.6%,and the negative predictive value was 71.2%.The CDU images of metastatic lymph nodes showed that the cystic changes(15.7%),punctate hyperecho(34.7%),peripheral blood flow(40.5%),and the high echo of the portal(80.2%)were significantly higher than the reactive hyperplasia lymph nodes(0.0%,0.0%,0.0%,11.7%,respectively,all P<0.05).The blood flow abundance of metastatic lymph nodes was significantly higher than that of the reactive hyperplasia lymph nodes(P<0.05).The peak systolic velocity(PSV)(35.72±6.63 cm/s)and resistance index(RI)(0.77±0.08)of metastatic lymph nodes were significantly higher than the reactive hyperplasia lymph nodes(24.15±8.27 cm/s,0.61±0.09,P<0.05),but the pulsatility index(PI)values were not significant difference(P>0.05).Lymph nodes metastasis were mainly in area VI,followed by areaⅡandⅣ.Conclusions High-frequency CDU can distinguish the characteristics of TC cervical lymph node metastasis and may have high diagnostic value.