双源CT联合超声对甲状腺乳头状癌中央区淋巴结转移的诊断价值

Diagnostic value of dual-source CT and ultrasound in central lymph node metastasis of papillary thyroid carcinoma

目的:探讨双源CT增强扫描与超声在甲状腺乳头状癌(PTC)患者术前颈部中央区淋巴结(CLN)评估中的价值。方法:回顾性分析经病理证实的239例PTC患者术前颈部CLN的CT和超声图像,比较双源CT、超声及两者联合术前评估颈部CLN的敏感度、特异度及准确率。结果:根据甲状腺内原发灶的大小和数量,将239例分成4组:A组,89例89个,单发,肿瘤直径≤1 cm;B组,47例139个,多发,直径≤1 cm;C组,63例63个,单发,直径>1 cm;D组,40例116个,多发,直径>1 cm。239例中,CLN转移132例,其中A组38例,B组24例,C组41例,D组29例。双源CT检测颈部CLN转移准确率76.1%,超声准确率75.4%,双源CT联合超声准确率79.1%;A组颈部CLN转移,超声准确率(74.2%)高于双源CT(69.5%)(P<0.05);B组联合检查敏感度(88.9%)高于双源CT(77.4%)(P<0.05);C组超声敏感度(65.1%)和准确率(69.0%)均低于双源CT(77.4%,77.9%)及联合检查(91.1%,84.5%)(均P<0.05),联合检查的敏感度(91.1%)高于双源CT(77.4%)(P<0.05);D组超声、双源CT和联合检查间的诊断效能差异均无统计学意义(均P>0.05)。结论:当肿瘤直径>1 cm且单发时,双源CT联合超声对颈部CLN转移具有较好的诊断效能。

Objective:To explore the value of dual-source CT enhanced scan and ultrasound in preoperative evaluation of cervical central lymph node(CLN)in patients with papillary thyroid carcinoma(PTC).Methods:The preoperative dual-source CT and ultrasound images of 239 patients with PTC confirmed by pathology were retrospectively analyzed.The sensitivity,specificity and accuracy of dual-source CT,ultrasound and dual-source CT combined ultrasound in preoperative evaluation of CLN were compared.Results:The 239 patients were divided into 4 subgroups according to the lesion size and number,group A were with tumor diameter≤1 cm and single lesion(89 cases,89 lesions),group B with diameter≤1 cm and multiple nodules(47 cases,139 lesions),group C with diameter>1 cm and single lesion(63 cases,63 lesions),group D with diameter>1 cm and multiple nodules(40 cases,116 lesions).Among the 239 cases,132 cases had CLN metastasis,38 cases were in group A,24 cases in group B,41 cases in group C,29 cases in group D.The accuracy for the diagnosis of CLN metastasis of dual-source CT,ultrasound,dual-source CT combined ultrasound was 76.1%,75.4%,79.1%,respectively.For the diagnosis of cervical CLN metastasis in group A,the accuracy of ultrasound was 74.2%,which was higher than that of dual-source CT alone of 69.5%(P<0.05).For the diagnosis in group B,the sensitivity of dual-source CT combined ultrasound was 88.9%,which was higher than that of dual-source CT alone of 77.4%(P<0.05).For the diagnosis in group C,the sensitivity and accuracy of ultrasound were 65.1%and 69.0%,which were lower than those of dual-source CT(77.4%,77.9%)and the combined examination(91.1%,84.5%)(all P<0.05),and the sensitivity of the combined examination was 91.1%,which was higher than that of dual-source CT of 77.4%(P<0.05).For the diagnosis in group D,there were no statistically significant differences in accuracy,sensitivity and specificity among the three methods(all P>0.05).Conclusions:Dual-source CT combined with ultrasound has better diagnostic performances in the diagnosis of cervical CLN metastasis when the tumor is single and with diameter>1 cm.