甲状腺癌颈部淋巴结转移高频超声的鉴别诊断价值

目的:探讨高频超声对甲状腺癌患者颈部肿大淋巴结转移的鉴别诊断价值。方法:对甲状腺癌患者颈部淋巴结进行评估,用高频超声诊断并测量淋巴结,记录形态、回声、大小、部位,结果由病理证实。结果:77例甲状腺癌患者中45例出现颈部淋巴结转移,绝大多数转移淋巴结为圆形,无淋巴门的低回声结节。淋巴结的形态对提示转移较为可靠,圆形、纵横径比小于2的低回声淋巴结常提示转移。在转移性病灶中无淋巴门,内部有囊变或钙化明显较良性多见。转移性淋巴结更多位于颈部下1/3处。结论:高频超声对甲状腺癌患者颈部肿大淋巴结转移有较高的诊断准确率,能为临床诊断、治疗提供参考。     

超声在评价颈部恶性肿大淋巴结中的应用

背景与目的：转移癌与淋巴瘤是引起颈部恶性淋巴结肿大的常见原因。本研究通过两者的二维超声和彩色多普勒血流显像的不同表现,探讨超声在颈部恶性淋巴结诊断中的价值。方法：取我院2006年1月～2008年12月间99例颈部恶性淋巴结肿大患者和40例健康人为观察对象,根据病理结果将患者分为54例转移癌组和45例淋巴瘤组。采用高频超声进行观察,包括肿大淋巴结的形态、长短径比值（L／S）、内部回声、淋巴门的情况、血流分布特征,并对测量参数进行统计学分析。结果：和良性淋巴结比较,恶性淋巴结的形态趋于圆形,L／S值小于对照组,以低回声为主,形态多样,易于融合,淋巴门缺失或移位,转移癌组可钙化和液化。转移癌组和淋巴瘤组声像图和血流特征存在差异,并可与良性淋巴结进行鉴别。结论：超声可作为评价颈部肿大恶性淋巴结的手段之一。     

超声对甲状腺癌患者颈部淋巴结转移的诊断价值

目的 探讨超声对甲状腺癌患者颈部淋巴结转移的诊断价值。方法 选取120例甲状腺癌患者,均接受超声检查。根据是否发生颈部淋巴结转移将患者分为转移组和未转移组,比较转移组与未转移组患者颈部淋巴结的超声特征,分析超声对甲状腺癌患者颈部淋巴结转移的诊断价值。结果 转移组与未转移组患者门部回声不均匀、微钙化的比例比较,差异均无统计学意义（P﹥0.05）。转移组患者皮质增厚、长短径比﹤2、淋巴门偏移、边界不清、淋巴结融合、血流丰富比例均明显高于未转移组,差异均有统计学意义（P﹤0.01）。超声特征中皮质增厚、长短径比﹤2、淋巴门偏移、边界不清、淋巴结融合、血流丰富诊断甲状腺癌颈部淋巴结转移的灵敏度和特异度均高于60%。结论 甲状腺癌患者颈部淋巴结的超声表现有助于鉴别淋巴结性质,超声检查对甲状腺癌淋巴结转移的诊断价值较高,能够指导临床制订合适的治疗方案。     

超声对甲状腺乳头状癌颈部淋巴结转移规律及特点的评价

目的:探讨超声对甲状腺乳头状癌（papillary thyroid cancer,PTC）颈部淋巴结转移规律及特点的价值。方法:回顾性分析 91例（112侧）颈部阳性淋巴结（cN+）PTC患者的声像图特征,分为术前颈部淋巴结触诊阳性患者61侧和术前颈部触诊阴性而超声提示为颈淋巴转移患者51侧两组。记录术中转移淋巴结的数量及在Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ 区的分布。结果:PTC颈部转移性淋巴结的超声特点以类圆形及淋巴门消失多见,内部呈低回声伴钙化、囊性变或呈高回声。91例患者中21例双侧颈转移占23.1％,112侧颈清扫标本中89侧（79.5％）为多分区转移;颈转移淋巴结在Ⅱ区57.1％（64/112）、Ⅲ区56.3％（63/112）、Ⅳ区61.6％（69/112）、Ⅵ区67.9％（76/112）。Ⅴ区仅占18.8％（21/112）,差异有统计学意义（P<0.001）。术前超声检查可以发现45.5％（51/112）的颈部触诊漏诊的颈部淋巴转移。结论:PTC的颈部淋巴转移可以多区分布,其中Ⅱ、Ⅲ、Ⅳ、Ⅵ区为主要的转移部位,Ⅵ区相对较高,颈部转移性淋巴结呈类圆形及淋巴门消失多见,内部呈低回声伴钙化、囊性变或呈高回声。超声在PTC颈淋巴转移的诊断中具有重要的价值。     

高频彩超对甲状腺癌颈部淋巴结转移诊断价值的探讨

目的:探讨高频彩超对甲状腺癌患者颈部淋巴结转移的诊断价值.方法:回顾性分析65例甲状腺癌患者术前甲状腺和颈部淋巴结的超声表现,比较转移性淋巴结和非转移性淋巴结在二维超声和彩色多普勒超声的表现.结果:转移和非转移淋巴结组问淋巴结纵横比<1.5、边缘缺损、内部回声欠均匀以及微钙化等超声指标差异均有统计学意义,P<0.05.转移淋巴结中血流分布较丰富,多普勒血流收缩期峰值流速(Vmax)和阻力指数(RI)也高于非转移淋巴结,P<0.05.肿瘤>2cm组、肿瘤边界不清或锯齿状的颈部淋巴结转移发生率明显增高,P<0.05;颈部淋巴结转移组较未转移组痛灶内彩色血流信号丰富,P<0.05;而肿瘤内是否出现钙化与甲状腺癌是否发生颈部淋巴结转移无相关性,P>0.05.结论:高频彩超对术前甲状腺癌颈部淋巴结转移具有重要的诊断价值.     

术前超声分区诊断甲状腺癌颈淋巴结转移的临床价值

目的:探讨甲状腺癌颈部淋巴结转移的规律,评价术前超声分区诊断甲状腺癌颈部淋巴结转移的临床价值。方法:回顾性分析行颈部淋巴结清扫手术的568 例甲状腺癌患者的临床资料,术前均行甲状腺超声检查,同时对颈部转移性淋巴结进行分区,记录淋巴结的数量及在颈部Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ及Ⅻ区的分布,与术后病理进行比较。结果:超声诊断甲状腺癌的符合率为88% ,392 例淋巴结阳性病例中289 例患者为多分区转移,转移性淋巴结在颈部的分布以Ⅱ、Ⅲ、Ⅳ、Ⅵ区为主,Ⅴ、Ⅻ区转移性淋巴结分布较少。术前超声对颈部淋巴结诊断的总体符合率为80% ,术前超声分区对Ⅲ、Ⅳ、Ⅵ及Ⅶ区的转移性淋巴结的诊断符合率较高。结论:术前超声诊断转移性淋巴结的临床符合率较高。甲状腺癌的颈部淋巴转移为多分区分布,术前超声分区对Ⅲ、Ⅳ、Ⅵ及Ⅶ区转移性淋巴结的诊断符合率较高,可以做到定位、定性及定量诊断,指导临床手术方式的选择,患者术前行超声检查时应常规对颈部淋巴结进行术前分区。      

超声诊断甲状腺癌颈部淋巴结转移的特点及其临床诊断价值

目的 探究超声诊断甲状腺癌颈部淋巴结转移的特点及其临床诊断价值.方法 选取51例甲状腺癌患者为研究对象,利用超声对患者的甲状腺及颈部肿大淋巴结进行诊断,并将超声诊断结果与术后病理诊断结果进行比较.结果 经超声探测的51例患者颈部转移性淋巴结为109枚,非转移性淋巴结16枚;术后病理检测患者颈部转移性淋巴结98枚,非转移性淋巴结12枚.与术后病理检测结果对比,利用超声检测患者颈部淋巴结转移的准确率为88.0％,敏感度为64.8％,特异度为85.3％,阳性预测值为80.7％,阴性预测值为66.7％.超声对多个淋巴结转移的检出率明显高于单个淋巴结转移的检出率,二者差异有统计学意义(x2=6.736,P=0.031);甲状腺癌肿瘤边界不清或呈锯齿状、肿瘤直径＞2 cm的颈部淋巴结转移率较高,并且转移性淋巴结的血流信号多于非转移性淋巴结,差异有统计学意义(P＜0.05).结论 利用超声诊断甲状腺癌颈部淋巴结转移的准确率较高,可在临床推广应用.     

超声检查对甲状腺癌颈部淋巴结转移的诊断价值

目的 探讨超声检查对甲状腺癌颈部淋巴结转移的诊断价值。方法 选取143例甲状腺癌患者,所有患者均进行超声检查。以病理检查结果为金标准,分析超声对甲状腺癌颈部淋巴结转移的诊断效能,比较颈部淋巴结转移与未转移患者的超声征象和血流动力学指标。结果 术后病理检查结果显示,143例甲状腺癌患者中,颈部淋巴结转移81例,未转移62例;超声检查结果显示,颈部淋巴结转移98例,未转移45例。超声检查诊断甲状腺癌颈部淋巴结转移的灵敏度为90.12%,特异度为59.68%,准确度为76.92%,阳性预测值为74.49%,阴性预测值为82.22%。甲状腺癌颈部淋巴结转移患者中肿瘤边界不清晰、肿瘤直径﹥2 cm、淋巴结门部回声不均匀、淋巴门消失、淋巴结内部钙化的比例均高于颈部淋巴结未转移患者,差异均有统计学意义（P<0.05）。甲状腺癌颈部淋巴结转移患者的阻力指数（RI）、搏动指数（PI）、收缩期峰值流速/舒张末期流速（S/D）均明显高于颈部淋巴结未转移患者,差异均有统计学意义（P<0.01）。结论 超声检查对甲状腺癌颈部淋巴结转移的诊断效能较好,超声征象与患者颈部淋巴结转移情况存在一定联系,可为...     

甲状腺癌颈部淋巴结转移区域的超声特点研究

目的：探究甲状腺癌颈部淋巴结转移区域的超声特点。方法回顾性分析58例甲状腺癌患者的临床资料。将患者术前颈部淋巴结转移区域的超声诊断与患者的病理诊断进行比较,分析其超声表现的特点。结果58例患者中经术前超声诊断显示,有36例（62．07％）颈部淋巴结转移,其中3例单纯中央区淋巴结转移、18例单纯颈侧区淋巴结转移、15例颈侧区合并中央区淋巴结转移;中央区淋巴结转移率为31．03％,显著低于颈侧区淋巴结转移率56．89％。病理诊断结果显示,58例患者中有33例（56．89％）颈部淋巴结转移,其中21例单纯中央区淋巴结转移,2例单纯颈侧区淋巴结转移,10例颈侧区合并中央区淋巴结转移;中央区淋巴结转移率为53．44％,显著高于颈侧区淋巴结转移率20．68％。超声诊断颈部转移性淋巴结的特异性为80．0％（12／15）,敏感性为100．0％（33／33）。超声检查对中央区转移性淋巴结的检出率为58．06％（18／31）,显著低于颈侧区转移性淋巴结的检出率100．0％（12／12）。超声诊断颈侧区淋巴结转移与病理结果的符合率为36．36％（12／33）,显著低于中央区淋巴结转移与病理结果的符合率58．06％（18／31）,差异具有统计学意义（P＜0．05）。颈侧区和中央区中淋巴门回声消失和低回声占较高的比例,且颈侧区和中央区颈侧区转移性淋巴结中L／T＜2所占的比例差异具有统计学意义（P＜0．05）。结论甲状腺癌多转移至颈部中央区淋巴结,采用超声检查具有较高的特异性,对中央区淋巴结的诊断有十分重要的意义。     

颈部超声、甲状腺球蛋白诊断复发分化型甲状腺癌

背景与目的：颈部超声与血清甲状腺球蛋白(thyroglobulin,Tg)是分化型甲状腺癌(differentiated thyroid carcinoma,DTC)术后随访的主要方法。刺激性Tg对分化型甲状腺癌的诊断价值已被充分证实,但抑制性Tg对DTC复发转移的诊断价值鲜有报道。该研究分析颈部超声及抑制性Tg对DTC复发转移的诊断价值。方法：回顾性分析2010年8月—2014年12月在北京协和医院行2次或以上手术,临床怀疑复发的DTC患者196例。选择其中入院前行甲状腺全切术后和(或)131I清甲治疗术后超声怀疑复发转移的患者共62例。分析转移性淋巴结超声特征以及抑制性Tg对DTC复发转移的诊断价值。结果：经病理证实,62例患者中59例为淋巴结转移,1例为局部复发,2例术后未发现明确复发转移。超声发现可疑淋巴结共121个,经病理证实转移性淋巴结92个,非转移性淋巴结25个,纤维组织3个,横纹肌组织1个。淋巴结内无回声、高回声及强回声对转移性淋巴结的阳性预测值均为100%,皮质内无回声及血流信号杂乱在转移性淋巴结和非转移淋巴结中差异有统计学意义。抑制性Tg阳性者(Tg≥0.2 ng/mL)49例,阴性者(Tg＜0.2 ng/mL)13例,抑制性Tg诊断颈部复发转移的准确率为82.3%,灵敏度为81.7%,特异度为100%。结论：皮质内无回声及血流信号杂乱是鉴别复发DTC颈部转移性淋巴结与非转移性淋巴结特异度较高的指标,抑制性Tg(Tg≥0.2 ng/mL)对DTC的复发转移有较高的诊断价值,颈部超声检查可发现血清Tg为阴性患者的复发转移病灶。     

Diagnostic imaging of differentiated thyroid carcinoma

The role of diagnostic imaging in differentiated thyroid carcinoma is analyzed. 99mTc-pertechnetate 123I and 131I scintigraphy allows the evaluation of nodules with their differentiation in cold (hypofunctioning) and hot (functionally autonomous) nodules; thyroid carcinomas are cold nodules even if most of them are benign. On sonography thyroid nodules are well visualized with the definition of their site, number, size (not very useful parameters for the diagnosis of malignancy), echoic structure, and vascularization on color Doppler. The sonographic findings suggestive of differentiated thyroid carcinoma are: solid and hypoechoic structure, irregular ill-defined margins, absent or discontinuous peripheral ring, microcalcification, intranodular vascularization, local lymphadenopathies. These findings are characteristic but not pathognomonic, mostly for papillary carcinoma, while in the frequently isoechoic follicular carcinoma microcalcification and lymph node metastases are rare. Only the finding, although rather infrequent, of the dissemination to adjacent structures (muscles and vessels) is a definite indication for malignancy of a thyroid nodule. Color Doppler sonography plays a major role in the postoperative staging and follow-up, in combination with thyroglobulin determination and 131I whole body scintigraphy and it allows the detection of local and/or laterocervical lymph node recurrence. The most typical sonographic findings of metastatic lymphadenopathy are the roundish shape (length/anteroposterior diameter ratio-L/A < 1.5), not visible or displaced nodal hilum, thickened cortical layer with echoic structure similar to that of thyroid parenchyma, at times with microcalcification, cortical vascularization and dismantled angioarchitecture. CT and MRI are occasionally more useful to evaluate the substernal or retrosternal extension of voluminous thyroid masses and to identify local or distant metastases.     

Papillary thyroid microcarcinoma: a surgical perspective

Papillary thyroid microcarcinoma (PTMC) is defined as a papillary thyroid cancer measuring less than 10mm in its greatest diameter. It is the most common form of thyroid cancer, detected in up to 36% in autopsy studies. The wide availability and use of neck ultrasonography in the evaluation of carotid arteries and of the thyroid resulted in an increased detection of PTMC. PTMC is often multifocal. The diagnosis is usually based on a combination of clinical examination, laboratory investigations, and specialized radiological techniques (mainly neck ultrasonography combined with fine-needle aspiration cytology). A common scenario is the diagnosis of PTMC as an incidental finding following thyroidectomy for a presumably benign thyroid disease. Despite some controversy, most authors agree that PTMC should be treated by total or near-total thyroidectomy, provided it can be performed safely. Because of its many and major advantages, in our clinical practice, total or near-total thyroidectomy is the procedure of choice for the management of PTMC. Given the high incidence of PTMC as an incidental finding and the frequent multi-focality, we also favor total or near-total thyroidectomy for the surgical management of nodular thyroid disease (multinodular goiter or dominant presumably benign thyroid nodule/s). Despite some controversy, we perform central neck lymph node dissection electively, in the presence of cervical lymphadenopathy. Radioiodine ablation therapy may be used as an adjuvant therapy. Prognostic factors (such as tumor multicentricity, positive lymph nodes, capsular or vascular invasion) or scoring systems (such as the AMES) can be used to select patients for radioiodine adjuvant therapy. Suppression therapy is needed after surgical management. Despite the potential for neck lymph node and even distant metastases, the biological behavior of PTMC is in general benign and the prognosis is very good.     

Optimizing treatment for children and adolescents with papillary thyroid carcinoma in post-Chernobyl exposed region: The roles of lymph node dissections in the central and lateral neck compartments

There is lack of data to predict lymph node metastases in pediatric thyroid cancer. The aims are to study (1) the factors affecting the lymph node metastases in children and adolescence with papillary thyroid carcinoma in region exposed to radiation and (2) to evaluate the predictive significance of these factors for lateral compartment lymphadenectomy. Five hundred and nine patients with papillary thyroid carcinoma underwent total thyroidectomy and lymph nodes resection (central and lateral compartments of the neck) surgery during the period of 1991–2010 in Belarus were recruited. The factors related to lymph node metastases were studied in these patients. In the patients with papillary thyroid carcinoma, increase number of cancer-positive lymph nodes in the central neck compartment were associated with a risk to develop lateral nodal disease as well as bilateral nodal disease. Futhermore, positive lateral compartment nodal metastases are associated with age and gender of the patients, tumour size, minimal extra-thyroidal extension, solid architectonic, extensive desmoplasia in carcinoma, presence of psammoma bodies, extensive involvement of the thyroid and metastatic ratio index revealed after examination of the central cervical chain lymph nodes. The presence of nodal disease, degree of lymph node involvement and the distribution of lymph node metastases significantly increase the recurrence rates of patients with papillary thyroid carcinoma. To conclude, the lymph nodes metastases in young patients with papillary thyroid carcinoma in post-Chernobyl exposed region are common and the pattern could be predicted by many clinical and pathological factors.     

甲状腺全切除术治疗分化型甲状腺癌（附72例）

目的：探讨甲状腺全切除术治疗分化型甲状腺癌安全性的相关因素。方法：回顾性分析本院2002年1月至2010年1月期间72例甲状腺全切术治疗分化型甲状腺癌的病历资料,分析甲状旁腺功能减退和喉返神经损伤的发生情况。结果：甲状旁腺功能减退发生与再次手术、原发肿瘤腺体外侵犯、中央区淋巴结转移有关,与是否行颈清无关;喉返神经的损伤与上述因素无关。结论：影响甲状腺全切术治疗分化型甲状腺癌安全性的相关因素有：手术次数、原发肿瘤腺体外侵犯和中央区淋巴结转移。     

Papillary carcinoma of the thyroid with distant metastases to the cerebrum: a case report

Cerebral metastases from papillary carcinoma of the thyroid are a very uncommon condition, but such metastases behave more aggressively and show poor prognosis. These metastases almost always involve concomitant lung or bone metastases which may be the first metastatic sites. Here we report a 53-year-old man with diffuse goiter and cervical lymphadenopathy who developed symptoms of elevated intracranial pressure. Computed tomography demonstrated ring-enhanced lesions showing a severe mass effect in the right cerebrum and a nodule in the right thyroid gland accompanied by swollen lymph nodes. Biopsied specimens of the thyroid nodule demonstrated malignant cells of papillary carcinoma. Surgical excision of the metastatic brain lesions was followed by total thyroidectomy with regional lymphadenectomy. Histological examinations confirmed that the patient had cerebral metastases from papillary carcinoma of the thyroid without other distant metastasis. Neurological abnormality disappeared after surgery and treatment with radioactive iodine (131I) and oral thyroxine were initiated thereafter. This case suggests that the thyroid gland is potentially a primary source of metastatic brain carcinoma. Moreover, early detection of cerebral metastases is crucial because these metastatic lesions can be life threatening, in contrast to the relatively less severe clinical course of this malignancy unless it is associated with any distant metastasis.     

Risk of bilateral cervical lymph node metastases in papillary thyroid cancer

We evaluated the risk of bilateral or contralateral cervical lymph node metastases in 135 patients with papillary thyroid cancer who underwent bilateral neck dissection. We confirmed that bilateral jugular lymph node metastases were frequent in patients with obvious carcinoma in both lobes of the gland, in those with cancers arising in the isthmus, in those with clinically detectable bilateral lymphadenopathy, and in those with recurrent thyroid cancer. However, only 24% of the patients who had cancer clinically confined to one lobe with no bilateral or contralateral lymphadenopathy had histologically detected bilateral or contralateral jugular lymph node metastases. But the occurrence of contralateral jugular lymph node metastases was significantly correlated with both clinical lymphadenopathy in the ipsilateral neck and contralateral paratracheal lymph node metastases. Bilateral lymph dissection might be beneficial for these patients. © 1993 Wiley-Liss, Inc.     

cN0甲状腺乳头状癌侧颈淋巴结转移特点及其相关因素

 目的　探讨cN0甲状腺乳头状癌侧颈淋巴结转移特点及其相关危险因素。方法　回顾性分析73例接受同侧预防性颈清扫（Ⅱ～Ⅵ区或Ⅱ～Ⅳ区联合Ⅵ区）的cN0甲状腺乳头状癌患者临床资料,颈清扫淋巴结标本按颈部分区收集并送术后常规病理检查。 结果　73例cN0甲状腺乳头状癌患者中,侧颈淋巴结转移率为16.4 ％（12／73）,其中Ⅱa、Ⅱb、Ⅲ、Ⅳ、Va、Vb和Ⅵ区淋巴结转移率分别为9.6 %、0、13.6 %、9.6 %、0、4.8 ％和42.4 %,多因素分析显示Ⅵ区淋巴结转移是影响cN0甲状腺乳头状癌侧颈淋巴结转移的独立危险因素（OR＝7.3,P＝0.020）。结论　cN0甲状腺乳头状癌侧颈转移以Ⅱa、Ⅲ、Ⅳ区为主,预防性清扫应重点清扫上述三个分区;术中冷冻Ⅵ区阴性时,cN0甲状腺乳头状癌患者无需常规行侧颈预防性清扫。     

Follicular adenoma and carcinoma of the thyroid gland

Follicular neoplasms of the thyroid gland include benign follicular adenoma and follicular carcinoma. Currently, a follicular carcinoma cannot be distinguished from a follicular adenoma based on cytologic, sonographic, or clinical features alone. The pathogenesis of follicular carcinoma may be related to iodine deficiency and various oncogene and/or microRNA activation. Advances in molecular testing for genetic mutations may soon allow for preoperative differentiation of follicular carcinoma from follicular adenoma. Until then, a patient with a follicular neoplasm should undergo a diagnostic thyroid lobectomy and isthmusectomy, which is definitive treatment for a benign follicular adenoma or a minimally invasive follicular cancer. Additional therapy is necessary for invasive follicular carcinoma including completion thyroidectomy, postoperative radioactive iodine ablation, whole body scanning, and thyrotropin suppressive doses of thyroid hormone. Less than 10% of patients with follicular carcinoma will have lymph node metastases, and a compartment-oriented neck dissection is reserved for patients with macroscopic disease. Regular follow-up includes history and physical examination, cervical ultrasound and serum TSH, and thyroglobulin and antithyroglobulin antibody levels. Other imaging studies are reserved for patients with an elevated serum thyroglobulin level and a negative cervical ultrasound. Systemic metastases most commonly involve the lung and bone and less commonly the brain, liver, and skin. Microscopic metastases are treated with high doses of radioactive iodine. Isolated macroscopic metastases can be resected with an improvement in survival. The overall ten-year survival for patients with minimally invasive follicular carcinoma is 98% compared with 80% in patients with invasive follicular carcinoma.