超声检查对甲状腺乳头状癌及中央区淋巴结转移的诊断价值

Diagnostic value of ultrasonography for papillary thyroid carcinoma and central lymph node metastasis

目的分析超声检查对甲状腺乳头状癌(PTC)及中央区(Ⅵ区)淋巴结转移的诊断价值。方法选取153例甲状腺病变患者,术前均接受超声检查。以病理学检查为金标准,评估超声检查对PTC及Ⅵ区淋巴结转移的诊断价值。结果病理学检查结果显示,PTC 110例,结节性甲状腺肿43例。术前超声诊断PTC的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为97.27%、86.05%、94.69%、92.50%、94.12%。病理学检查结果显示,110例PTC患者发生Ⅵ区淋巴结转移48例,未发生Ⅵ区淋巴结转移62例,术前超声检查诊断110例PTC患者发生Ⅵ区淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为16.67%、95.16%、72.73%、59.60%、60.91%。淋巴结形态异常、淋巴结结构异常、微钙化聚集分布PTC患者Ⅵ区淋巴结转移率分别高于淋巴结形态正常、淋巴结结构正常、微钙化分散分布的患者,差异均有统计学意义(P﹤0.05)。结论术前超声检查对PTC有一定的诊断价值,淋巴结形态异常、淋巴结结构异常及微钙化聚集分布是PTC患者Ⅵ区淋巴结转移的重要超声表现,可用于术前预测,但准确度较低。

Objective To analyze the diagnostic value of ultrasonography for papillary thyroid carcinoma(PTC)and lymph node metastasis in the central area(region VI).Method 153 patients with thyroid disease were selected and all underwent ultrasound examination before operation.The pathological examination was used as the gold standard to evaluate the diagnostic value of ultrasonography for PTC and lymph node metastasis in region VI.Result Pathological results showed 110 cases of PTC and 43 cases of nodular goiter.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ultrasound diagnosis of PTC were 97.27%,86.05%,94.69%,92.50% and 94.12%,respectively;pathological results showed 48 cases with region VI lymph node metastasis and 62 cases without metastasis in 110 PTC patients;preoperative ultrasonography showed the sensitivity,specificity,positive predictive value,negative predictive value and accuracy in diagnosing region Ⅵ lymph node metastasis among 110 PTC patients were 16.67%,95.16%,72.73%,59.60% and 60.91%,respectively.The region Ⅵ lymph node metastasis rate in PTC patients with abnormal lymph node morphology,lymph node structure,and microcalcification aggregated distribution were higher than those without normal lymph node morphology,normal lymph node structure,and scattered distribution of microcalcifications(P<0.05).Conclusion Preoperative ultrasound examination has a certain diagnostic value for PTC.Abnormal lymph node morphology,abnormal lymph node structure and microcalcification accumulation are important ultrasound manifestations of lymph node metastasis in zone Ⅵ of patients with PTC,which can be used for preoperative prediction,but the accuracy is low.