SWE定量技术评价cN0期甲状腺乳头状癌中央区淋巴结的价值

The value of real-time shear-wave elastography in the differential diagnosis of lymph nodes in the central zone of cN0 stage papillary thyroid carcinoma

目的探讨评价实时剪切波弹性成像技术(SWE),对临床颈淋巴结阴性(cN0期)甲状腺乳头状癌(PTC)患者中央区淋巴结良恶性鉴别诊断的应用价值。方法选取并分析经病理证实的PTC患者78例126枚中央区淋巴结的弹性模量值,将其分为淋巴结转移组和淋巴结无转移组,对各组淋巴结的最大值、平均值、最小值(Emax、Emean、Emin值)进行统计分析,绘制ROC曲线并找出良恶性中央区淋巴结SWE的最佳诊断阈值。结果126枚颈部中央区淋巴结中,PTC转移性淋巴结79枚,非转移性淋巴结47枚。PTC转移性淋巴结的Emax、Emean和Emin值均大于无转移组淋巴结,ROC曲线分析结果显示,Emean值诊断效能最大,诊断阈值为27.8 kPa,其鉴别诊断的灵敏度为90.68%,特异性为88.37%。结论实时剪切波弹性成像Emean值可为cN0期PTC患者中央区淋巴结性质的判定提供诊断依据。

Objective To evaluate the value of real-time shear-wave elastography(SWE)in the differential diagnosis of benign and malignant lymph nodes in central zone of patients with negative cervical lymph node(cN0 stage)papillary thyroid carcinoma(PTC).Methods The elastic modulus value of 126 lymph nodes in central zone in 78 PTC patients confirmed by pathology were retrospectively analyzed,which can be divided into groups of lymph nodes without metastasis and lymph nodes metastasis,the Emax,Emean and Emin values of each node were analyzed statistically to find out the diagnostic threshold of benign and malignant lymph nodes and the ROC curve was drawn.Results Among the 126 lymph nodes in the central zone group,79 were metastatic lymph nodes and 47 were non-metastatic lymph nodes.The Emax,Emean and Emin values of PTC metastatic lymph nodes were higher than those of non-metastatic lymph nodes.ROC analysis showed that the Emean value had the greatest diagnostic efficiency,with a diagnostic threshold of 27.8 kPa.The sensitivity and specificity of the differential diagnosis were 90.68%and 88.37%,respectively.Conclusion Emean value of SWE can provide a basis for the determination of the nature of central lymph nodes in cN0 stage PTC patients,which has important clinical significance.