超声造影结合TI-RADS在甲状腺癌颈部淋巴结转移中的应用价值

Application value of contrast-enhanced ultrasound combined with TI-RADS in cervical lymph node metastasis of thyroid cancer

目的研究超声造影(contrast-enhanced ultrasound,CEUS)结合甲状腺结节分级系统(thyroid imaging reporting and data system,TI-RADS)在甲状腺癌颈部淋巴结转移(lymph node metastasis,LNM)中的应用价值。方法回顾性分析2019年5月至2023年2月台州市第一人民医院超声科80例甲状腺癌患者的临床资料,且颈部淋巴结存在不同程度肿大疑似LNM,均行CEUS及TI-RADS检查,以术后病理结果为"金标准",评估颈部LNM情况。结果甲状腺癌颈部LNM患者的上升时间(rise time,RT)和达峰时间(time-to-peak velocity,TTP)分别为(8.21±2.69)s和(13.92±3.10)s,未转移患者的RT和TTP分别为(8.63±2.91)s和(14.85±3.74)s,甲状腺立癌颈部LNM患者与未转移患者的RT和TTP比较,差异均无统计学意义(P>0.05);甲状腺癌颈部LNM患者的峰值强度(peak intensity,PI)为(9.36±3.24)dB,大于未转移患者的PI(5.48±1.67)dB,差异有统计学意义(P<0.05)。经TI-RADS检查,甲状腺癌患者中颈部淋巴结1级32例、2级24例、3级12例、4级12例,颈部LNM共24例,颈部淋巴结未转移共56例,甲状腺癌颈部LNM真阳性20例,真阴性49例;CEUS诊断甲状腺癌颈部LNM真阳性21例,真阴性47例;CEUS诊断、TI-RADS诊断、联合诊断甲状腺癌颈部LNM的特异度(88.68%、92.45%、90.57%)、准确度(85.00%、86.25%、92.50%)比较,差异无统计学意义(P>0.05);联合诊断甲状腺癌颈部LNM的灵敏度(96.30%)高于CEUS诊断(77.78%)、TI-RADS诊断(74.07%),差异有统计学意义(P<0.05)。结论CEUS结合TI-RADS可提高甲状腺癌颈部LNM的诊断灵敏度,为临床诊治及改善预后提供科学依据。

Objective To study the application value of contrast-enhanced ultrasound(CEUS)combined with thyroid imaging reporting and data system(TI-RADS)in cervical lymph node metastasis(LNM)of thyroid cancer.Methods Clinical data of 80 patients with TC in the Ultrasonography Department of Taizhou First People’s Hospital from May.2019 to Feb.2023 were retrospectively analyzed.CEUS and TI-RADS were performed for cervical lymph nodes with different degrees of swelling suspected to be LNM.The postoperative pathological results were used as the"gold standard"to evaluate cervical LNM.Results The rise time(RT)and time-to-peak velocity(TTP)were(8.21±2.69)seconds and(13.92±3.10)seconds in patients with thyroid neck LNM,and(8.63±2.91)seconds and(14.85±3.74)in patients without metastasis,respectively.There was no significant difference in RT and TTP between patients with thyroid neck LNM and those without metastasis(P>0.05),and the peak intensity(PI)of patients with thyroid cancer with cervical LNM was(9.36±3.24)dB,which was greater than that of patients without metastasis(5.48±1.67)dB,and the difference was statistically significant(P<0.05).According to TI-RADS examination,there were 32 cases of grade 1,24 cases of grade 2,12 cases of grade 3 and 12 cases of grade 4,24 cases of cervical LNM.56 cases didn’t have cervical lymph node metastasis,cervical LNM true positive occurred in 20 cases,and 49 cases of true negative occurred in 49.21 cases of cervical LNM diagnosed by CEUS and 47 cases of true negative,and the specificity of CEUS diagnosis,TI-RADS diagnosis and combined diagnosis of cervical LNM for thyroid cancer was 88.68%,92.45%,90.57%.There was no significant difference in the accuracy(85.00%,86.25%,and 92.50%)(P>0.05),and the sensitivity(96.30%)of the combined diagnosis of cervical LNM for thyroid cancer was higher than that of CEUS(77.78%)and TI-RADS(74.07%),and the difference was statistically significant(P<0.05).Conclusion CEUS combined with TI-RADS can improve the diagnostic sensitivity of cervical LNM in TC,and provide scientific basis for clinical diagnosis and treatment and prognosis improvement.