常规超声与超声造影对甲状腺乳头状癌患者侧颈区淋巴结转移的术前诊断效能

Efficacy of Conventional Ultrasound and Contrast-enhanced Ultrasound in Preoperative Diagnosis of Lateral Cervical Lymph Node Metastasis from Papillary Thyroid Carcinoma

目的探讨常规超声(US)与超声造影(CEUS)在甲状腺乳头状癌(PTC)患者侧颈区淋巴结转移(LCLNM)术前诊断的超声特征,评价其在PTC侧颈区淋巴结转移的术前诊断效能。方法选取80例在昆明医科大学第二附属医院接受PTC手术及侧颈区淋巴结清扫术患者并获得126枚淋巴结超声检查资料。经术后病理证实,81枚为PTC转移性淋巴结,45枚为未转移性淋巴结。观察常规超声(US)及超声造影(CEUS)检查淋巴结转移声像图特征。与病理结果对比,计算US、CEUS及联合应用对PTC患者LCLNM的术前诊断的敏感度、特异度、准确度、阳性预测值、阴性预测值。结果US检查转移性淋巴结声像图特征多表现为淋巴门消失或偏移、皮质回声为非均匀低回声、内部存在团状高回声及钙化,血流类型多表现为周围型和混合型,血流分级多为Adler2级和3级,与非转移组比较,差异有统计学意义(P<0.05);CEUS检查转移性淋巴结声像图特征多表现为向心型和Ⅱ型,其次见于Ⅲ型;US与CEUS联合应用对于诊断PTC侧颈区淋巴结转移的敏感度、特异度、准确度、阳性预测值、阴性预测值均优于US或CEUS单独应用。结论术前US与CEUS联合应用能提高PTC患者侧颈区淋巴结转移的诊断效能,可以在临床上为超声引导下淋巴结细针穿刺细胞学检查和术前制定淋巴结清扫术及手术治疗策略提供参考依据。

Objective To investigate the ultransonic characteristics of conventional ultrasound(US)combined with Contrast-enhanced ultrasound(CEUS)in the pre-operative diagnosis effectiveness of lateral cervical lymph node metastasis(LCLNM)from papillary thyroid carcinoma(PTC),and to evaluate its efficacy in preoperative diagnosis of PTC lateral cervical lymph node metastasis.Methods A total of 80 patients who received PTC surgery and lateral cervical lymph node dissection in the Second Affiliated Hospital of Kunming Medical University were selected,and 126 lymph node ultrasonography data were obtained.Postoperative pathology confirmed that 81 lymph nodes were metastatic PTC and 45 lymph nodes were non-metastatic.The ultrasonographic features of lymph node metastasis were observed by conventional ultrasound(US)and contrast-enhanced ultrasound(CEUS).Compared with the pathological results,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of US,CEUS and combined application in the preoperative diagnosis of LCLNM in PTC patients were calculated.Results The ultrasonographic features of metastatic lymph nodes were mostly lymphatic portal disappearance or deviation.Cortical echo was non-uniform hypoecho,internal mass hyperecho and calcification,blood flow types were mostly peripheral type and mixed type,and blood flow grades were mostly Adler grade 2 and grade 3;compared with the non-metastatic group,the difference was statistically significant(P<0.05).The ultrasonographic characteristics of metastatic lymph nodes detected by CEUS were mostly centriotype and typeⅡ,followed by typeⅢ.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the combination of US and CEUS were superior to those of US or CEUS alone in the diagnosis of PTC lateral cervical lymph node metastasis.Conclusion Preoperative conventional ultrasound combined with CEUS can improve the diagnostic efficacy of lateral cervical lymph node metastasis from PTC.