超声引导FNA及FNA-Tg识别甲状腺乳头状癌淋巴结转移的临床价值

  目的  探讨在超声的识别和引导，以及FNA的精确取材基础上，FNA-Tg对可疑颈部甲状腺乳头状癌转移淋巴结的诊断意义，并建立FNA-Tg诊断值。  方法  对74枚甲状腺癌可疑转移淋巴结进行细针穿刺，结合手术病理，分别采用单纯FNA、FNA-Tg值与血清Tg对比、绘制 ROC曲线求取FNA-Tg最佳诊断值3种方法评估淋巴结，并求其判定阳性结果的灵敏性、特异性和准确率。  结果  淋巴结伴钙化、皮髓质分界、血供异常、纵横比在诊断甲状腺乳头状癌颈部淋巴结转移中的差异有统计学意义（P < 0.05），以上4项指标诊断甲状腺癌淋巴结转移的敏感度最高，钙化、多发片状高回声、囊性变及弹性成像硬度特异度较高，皮髓质分界及纵横比的准确率最高；FNA的敏感性、特异性及准确率为75%、100%和87.84%；FNA-Tg/血清Tg值 > 1为评判标准时的敏感性、特异性及准确率为97.22%、100%和 98.65%；绘制 ROC曲线求取FNA-Tg最佳诊断阈值为0.575 ng/mL。  结论  FNA-Tg/血清Tg > 1作为诊断甲状腺乳头状癌转移淋巴结的诊断标准能更好的规避因诸多因素带来的弊端，可有效降低误差率，应作为辅助诊断甲状腺乳头状癌淋巴结转移的首选。

Clinical Value of Ultrasound-guided FNA and FNA-TG in Identification of Lymph Node Metastasis of Papillary Thyroid Carcinoma

  Objective  To explore the diagnostic significance of FNA-Tg for lymph nodes with suspected cervical thyroid papillary carcinoma metastasis on the basis of ultrasonic detection and guidance and accurate biopsy of FNA, and establish the threshold of FNA-TG.   Methods  74 lymph nodes with suspected metastasis of thyroid cancer were evaluated by fine needle aspiration and analysed pathologically. Lymph nodes were evaluated by comparing FNA alone, FNA-TG value with serum Tg, and drawing ROC to obtain the best diagnostic value of FNA-TG, and the sensitivity, specificity and accuracy of positive results were evaluated.   Results  There were significant differences in calcification, cortex-medullary boundary, abnormal blood supply and aspect ratio in the diagnosis of cervical lymph node metastasis of papillary thyroid carcinoma （P < 0.05）. The above four indexes had the highest sensitivity in the diagnosis of lymph node metastasis of thyroid cancer. Calcification, multiple hyperecho, cystic changes and elastic imaging had higher hardness specificity, and the accuracy of cortex-medulla boundary and aspect ratio was the highest. The sensitivity, specificity and accuracy of FNA were 75%, 100% and 87.84%. The sensitivity, specificity and accuracy of FNA-Tg/ serum Tg value > 1 were 97.22%, 100% and 98.65%. ROC curve was drawn to obtain the optimal diagnostic threshold of FNA-Tg as 0.575 ng/mL.   Conclusion  FNA-Tg/ serum Tg > 1, as the diagnostic criteria for lymph node metastasis of papillary thyroid cancer, can better avoid the disadvantages caused by many factors and effectively reduce the error rate, and should be the first choice for the auxiliary diagnosis of lymph node metastasis of papillary thyroid cancer.