分化型甲状腺癌不同分区转移性淋巴结的超声影像特征及其临床意义

Ultrasonic image characteristics of different subregional metastatic lymph nodes of differentiated thyroid carcinoma and their clinical significance

目的 :探讨分化型甲状腺癌不同分区转移性淋巴结的超声影像特征及其临床意义。方法 :回顾分析本院100例经手术病理证实为分化型甲状腺癌患者临床资料,术前均进行彩色多普勒超声检查,根据其颈部淋巴结分区判断其转移性淋巴结分布情况。结果 :78例患者有颈淋巴结转移,其中60例为多分区转移者;术前超声检查显示淋巴结钙化征、淋巴结囊性变、淋巴结边界模糊、淋巴门消失、淋巴结高回声、纵横比≤2、多普勒血流周围型比例依次为21.0%、28.0%、90.0%、99.0%、83.0%、77.0%、89.0%;超声诊断淋巴结位于中央区的灵敏度、特异度依次为53.8%、65.8%,侧颈区为83.3%、86.1%;其转移趋势以中央区分布最多,侧颈区淋巴结转移以Ⅲ、Ⅳ区分布最高;根据超声成像图制定淋巴清扫方案,术后1年有3例颈淋巴结转移患者复发,但无患者死亡。结论 :超声可用于判断分化型甲状腺癌患术前是否发生颈淋巴结转移,并精确定位,为患者淋巴结清扫术提供参考,建议患者术前常规进行超声检查。

Objective To investigate the ultrasonic image characteristics of different subregional metastatic lymph nodes of differentiated thyroid carcinoma and their clinical significance. Methods The clinical data of 100 patients with differentiated thyroid carcinoma confirmed by operation and pathology were retrospectively analyzed. Color Doppler ultrasonography was performed before operation, and the distribution of metastatic lymph nodes was judged according to the subregion of cervical lymph nodes. Results There were 78 patients with cervical lymph node metastases, including 60 cases with multi-subregional metastases. Preoperative ultrasonography showed the proportions of lymph node calcification, cystic changes of lymph node, lymph nodes with fuzzy boundaries, lymph node hilus disappearing, high echo, aspect ratio ≤2 and peripheral type of blood flow were 21.0%, 28.0%, 90.0%, 99.0%, 83.0%, 77.0% and 89.0%, respectively. The sensitivity and specificity of ultrasound diagnosis for lymph nodes located in the central area were 53.8% and 65.8% respectively, while for lymph nodes located in the lateral cervical area were 83.3% and 86.1%, respectively. Metastases were the most in the central area, while lateral cervical lymph node metastases were the most in Ⅲ and Ⅳ areas. The lymph node dissection plan was made according to ultrasonic images.1 year after the operation, there were 3 cases with cervical lymph node metastases and none died cases. Conclusion Ultrasound can be used to determine the presence of cervical lymph node metastasis in patients with differentiated thyroid carcinoma before operation, with accurate positioning, which provides a reference for lymph node dissection. Preoperative ultrasonography is recommended for patients.