超声和双源CT对甲状腺癌颈部淋巴结转移及转移负荷的诊断价值

Diagnostic value of ultrasound and dual-source CT in cervical lymph node metastasis and metastatic burden in thyroid cancer

目的:探究超声和双源CT对甲状腺癌患者颈部淋巴结转移及其负荷状态的诊断价值。方法:回顾性分析行手术治疗的186例经病理证实的甲状腺癌患者的病理及影像资料,评估超声、双源CT对颈部淋巴结转移及不同淋巴结转移负荷状态的诊断效能。结果:186例经病理证实的甲状腺恶性肿瘤患者中,颈部淋巴结转移121例(65.1%)。双源CT对中央区颈部淋巴结转移的诊断敏感度高于超声(67.5%vs.39.3%);2种方法在颈侧区的敏感度均为79.5%;但超声对颈侧区和中央区颈部淋巴结转移诊断特异度比双源CT更高(96.5%vs.92.1%,95.7%vs.71.0%)。超声联合CT弥补了超声对中央区淋巴结转移诊断敏感度低的缺陷,且提升了CT对颈侧区淋巴结诊断的特异度,两区的AUC均得到提升。且超声对转移性淋巴结的诊断结果与淋巴结转移高负荷显著相关(r=0.541,P<0.05)。结论:超声联合双源CT可评估甲状腺癌患者淋巴结转移情况,有助于临床制订下一步治疗方案。

Objective:To assess the diagnostic value of ultrasound and dual-source CT in detecting cervical lymph node metastasis(LNM)and evaluating the metastatic burden in patients with thyroid cancer.Methods:The pathological and imaging data of 186 patients with thyroid cancer were retrospectively analyzed.The diagnostic efficacy of ultrasound,dual-source CT in predicting cervical LNM and assessing the metastatic burden were compared.Results:Among 186 patients with thyroid cancer,121 cases(65.1%)had cervical LNM.The sensitivity of dual-source CT in the diagnosis for LNM in the central region was higher than that of ultrasound(67.5%vs.39.3%),and the sensitivity of dual-source CT in the diagnosis for LNM in the lateral neck region was the same as that of ultrasound(79.5%vs.79.5%).The specificities of ultrasound in the diagnosis of LNM in the lateral neck region and the central region were higher than those of dual-source CT(96.5%vs.92.1%,95.7%vs.71.0%).Ultrasound combined with dual-source CT improved the sensitivity of ultrasound to cervical LNM in central region and the specificity of CT to cervical LNM in lateral region,and the AUCs increased.Ultrasound diagnosis of LNM was significantly correlated with high burden of LNM(r=0.541,P<0.05).Conclusion:The combination of ultrasound and dual-source CT for assessing cervical LNM in patients with thyroid carcinoma is beneficial in guiding treatment decisions.