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。     

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。     

EBUS-TBNA超声内镜对纵隔肿大淋巴结良恶性的鉴别诊断价值

目的:分析超声内镜引导下经支气管针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)术中肿大纵隔淋巴结的超声图像特点,探讨EBUS-TBNA超声内镜对纵隔淋巴结良恶性的鉴别诊断价值,以期提高EBUS-TBNA对纵隔淋巴结恶性病变的活检率。方法:回顾性分析2014年10月至2018年11月行EBUS-TBNA患者的超声内镜图像。我们使用以下EBUS超声内镜特征来预测淋巴结的良恶:回声,长轴长度,短轴长度,纵横比,形态,边界,淋巴门有无,淋巴结内血流信号分级。将超声检查结果与最终病理结果或临床随访结果进行比较。采用SPSS 20.0软件进行统计学分析,采用logistic回归分析评价肿大淋巴结EBUS-TBNA超声内镜下的特征与良恶性的相关性,以 P<0.05 为标准判定差异有统计学意义。结果:对130例纵隔淋巴结肿大患者的227个淋巴结进行回顾性分析,67.4%的肿大淋巴结被证实为恶性转移。Logistic回归分析显示回声、长轴及短轴的长度、正常淋巴门结构的消失是诊断恶性淋巴结的独立预测因素。结论:纵隔恶性淋巴结具有一定的超声特征,可以通过这些超声特征提高EBUS-TBNA对纵隔恶性淋巴结的检出率。     

Diagnostic Accuracy of Ultrasonography in Differentiating Benign and Malignant Thyroid Nodules Using Fine Needle Aspiration Cytology as the Reference Standard

Background: In Pakistan thyroid cancer is responsible for 1.2% cases of all malignant tumors. Ultrasonography(US) is helpful in detecting cancerous thyroid nodules on basis of different features like echogenicity, margins,microcalcifications, size, shape and abnormal neck lymph nodes. We therefore aimed to calculate diagnosticaccuracy of ultrasound in detection of carcinoma in thyroid nodules taking fine needle aspiration cytology asthe reference standard. Materials and Methods: A cross-sectional analytical study was designed to prospectivelycollect data from December 2010 till December 2012 from the Department of Radiology in Aga Khan UniversityHospital, Karachi, Pakistan. A total of 100 patients of both genders were enrolled after informed consent viaapplying non-probability consecutive sampling technique. Patients referred to Radiology department of AgaKhan University to perform thyroid ultrasound followed by fine-needle aspiration cytology of thyroid noduleswere included. They were excluded if proven for thyroid malignancy or if their US or FNAC was conductedoutside our institution. Results: The subjects comprised 76 (76%) females and 24 males. Mean age was 41.8±SD12.3 years. Sensitivity and specificity with 95%CI of ultrasound in differentiating malignant thyroid nodulefrom benign thyroid nodule calculated to be 91.7% (95%CI, 0.72-0.98) and 78.94% (0.68-0.87) respectively.Reported positive predictive value and negative PV were 57.9% (0.41-0.73) and 96.8% (0.88-0.99) and overallaccuracy was 82%. Likelihood ratio (LR) positive was computed to be 4.3 and LR negative was 0.1. Conclusions:Ultrasonography has a high diagnostic accuracy in detecting malignancy in thyroid nodules on the basis offeatures like echogenicity, margins, micro calcifications and shape.     

超微血管成像背景下超声造影在甲状腺乳头状癌患者颈侧区淋巴结中的鉴别诊断价值

目的 探讨超微血管成像(SMI)技术背景下超声造影(CEUS)对甲状腺乳头状癌(PTC)患者颈侧区淋巴结良恶性的鉴别诊断价值.方法 选取在郑州大学第一附属医院行PTC手术及颈部淋巴结清扫术的63例患者,共计98枚淋巴结,术前均行彩色多普勒(CDFI)、超微血管成像(SMI)、SMI+超声造影(CEUS),观察淋巴结的血...     

Hemangioendothelioma of the lymph node: a case report

Primary benign vascular tumors of lymph nodes are very rare. Various forms of lymph nodal vascular transformations defined as hemangiomatoid lesions, pannodal vasodilatation, or nodal angiomatosis have been described. We present a patient who was thought to have an epithelial salivary gland tumor, but instead was found to have an hemangioendothelioma of an adjacent enlarged lymph node in the region of the left submandibular gland.     

Cavitary mucoepidermoid carcinoma of lung with metastases in skeletal muscles as presenting features: a case report and review of the literature

Mucoepidermoid carcinomas (MECs) of lung are rare neoplasms originating in bronchial submucosal glands and comprising 0.1-0.2% of primary lung cancers. MECs, the most common malignancy in salivary glands, were earlier thought to occur only in salivary glands. Later studies showed that they can arise as a primary in bronchus, esophagus, lacrimal glands, pancreas, thymus and thyroid gland. Initially described as a benign adenoma, it is now considered to be a malignant epithelial tumor. There have been reports of metastases to regional lymph nodes, other parts of the lung and distant organs. Cavitary lesion in MEC of lung is rare. Here, we report a case of MEC of lung with metastases to skeletal muscles of thigh and arm. To the best of our knowledge, this is the only case of MEC of lung presenting with such unusual pattern of metastasis as presenting feature with almost no symptoms of primary lesion.     

Thin-needle aspiration biopsy: the diagnosis of head and neck tumors revisited.

Results of 567 thin-needle aspiration biopsies of head and neck lesions are reviewed. Cases included lymph nodes, salivary glands, thyroid, soft tissue and bone lesions. For the entire series, 17 patients had unsatisfactory aspirations. There were 12 false negative reports and 4 false positive reports, rates of 2.1% and 0.7%, respectively. No radical treatment resulted from false positive diagnoses and no patient delay in treatment occurred because of false negative reports. In the case of benign and malignant tumors, reports were histologically specific in more than 98% of the cases. This technique is simple to perform and saves time and hospital costs. Thin-needle aspiration biopsy can be effectively used in the management and diagnosis of head and neck tumor patients where close cooperation of the clinician and cytopathologist exists.     

甲状腺病变的多层螺旋CT诊断及鉴别诊断

目的 分析甲状腺病变的多层螺旋CT表现,探讨甲状腺良、恶性病变的诊断及鉴别诊断要点。方法 分析76例甲状腺病变患者的多层螺旋CT表现,其中6例患者一侧甲状腺为良性病变,另一侧为恶性病变,共计良性病变42例,恶性病变40例。双盲法评价病变边缘、密度变化及有无颈部淋巴结肿大,对照病理结果,采用,检验分析各种征象对于良、恶性病变中的评价有无统计学差异。结果 良性病变42例,病变清晰38例（90．5％）,有多发、孤立、规则低密度结节13例（30．9％）,颗粒状钙化3例（7．1％）,颈部淋巴结肿大2例（4．8％）。甲状腺癌40例,边缘模糊37例（92．5％）,病变内未见多发、散在、规则低密度结节,颗粒状钙化14例（35．0％）,颈部淋巴结肿大31例（77．5％）。增强扫描甲状腺癌34例,病变出现混杂密度19例（55．9％）;增强扫描良性病变32例,2例（6．3％）为混杂密度。经统计学处理,病变边缘是否清晰,有无多发、孤立、规则低密度结节,有无颗粒样钙化,是否伴有颈部淋巴结肿大,增强扫描病变内有无混杂密度,在甲状腺良、恶性病变之间差异有统计学意义（P〈0．01）。结论 病变边缘清晰,有多发、孤立、规则低密度结节,是甲状腺良性病变的诊断要点;病变边缘模糊,增强扫描病变内有混杂密度,有颗粒状钙化,伴有颈部淋巴结肿大,为诊断甲状腺癌较为可靠的征象。     

The role of high resolution pulsed and color Doppler ultrasound in the differential diagnosis of benign and malignant lymphadenopathy: results of multivariate analysis.

BACKGROUND: The role of high resolution pulsed and color Doppler ultrasound in the differential diagnosis of benign and malignant lymphadenopathy is still unclear. METHODS: High resolution pulsed and color Doppler ultrasound was used prospectively to investigate superficial lymph node enlargement in 71 patients undergoing surgical biopsy at the onset of lymphadenopathy. The aim of this study was to define, in multivariate analysis, the ultrasonographic parameters useful in the differential diagnosis of benign and malignant lymphadenopathy. RESULTS: Volume, vascularization score, pulsatility index, and resistive index were significantly higher in the 53 malignant lymph nodes studied than in the 18 benign lymph nodes studied. The long-to-short axis ratio was significantly lower in neoplastic lymph nodes than in reactive lymph nodes. Stepwise logistic regression selected only the long-to-short axis ratio and the vascularization score as parameters that independently and significantly contributed to the differentiation of neoplastic from reactive lymph nodes. The diagnostic efficiency of the combined criteria evaluated by the area under the receiver operating characteristic curve was 0.8339. CONCLUSIONS: High resolution pulsed and color Doppler ultrasound may provide information that is useful in making correct differential diagnoses of malignant or benign lymphadenopathy.     

Accuracy of Fine Needle Aspiration Cytology in Head and Neck Masses

In ENT clinical practice patients with neck swelling is a common presentation. To know their exact nature a simple, sensitive and diagnostic tool is required to prevent unnecessary costlier investigation and corresponding treatment. Fine needle aspiration cytology (FNAC) is a very safe, sensitive and diagnostic tool. This study was done to know the diagnostic accuracy, sensitivity and specificity of the FNAC in head and neck masses. Present prospective study was done in 179 patients of head and neck masses which were subjected to FNAC and their results were later correlated with histopathological examination report (HPR) wherever available. Out of 179 FNAC, HPR available only in 152 cases. In present study 104 cases (58.10 %) of lymph node, 35 cases (19.55 %) of thyroid gland, 17 cases (9.49 %) of salivary gland, 12 cases (6.70 %) of soft tissue and 11 cases (6.14 %) of miscellaneous swellings were present. The sensitivity, specificity, positive predictive value and negative predictive value of present study were 81.8, 95.0, 81.8 and 95.0 % respectively. The accuracy was 92.10 %.     

甲状腺切除联合同期双侧颈淋巴结清扫术治疗分化型甲状腺癌

目的 探讨分化型甲状腺癌行甲状腺切除联合同期双侧颈淋巴结清扫（颈清）术的安全性、适应证和手术难点。方法对1991年1月至2004年6月我科收治的分化型甲状腺癌行甲状腺切除联合同期双侧颈清术患者36例作回顾性分析,手术切口选择根据原发癌灶的位置及颈淋巴结可疑转移情况,选择相应的H型、L型或衣领式,甲状腺组织行近全切或全切,双侧颈清术原则上按保留颈内静脉、副神经、胸锁乳突肌改良颈清术式进行。结果全组36例患者无一例手术死亡,术后并发症为创口出血2例,一侧喉返神经损伤4例,一侧喉上神经内支损伤2例,一侧喉上神经外支损伤9例,一侧副神经损伤3例,一侧颈交感神经损伤5例,一侧膈神经损伤2例,一侧乳糜瘘6例,暂时性甲状旁腺功能减退13例,永久性甲状旁腺功能减退3例。淋巴结阳性数0-21个,平均8．3个／例,双侧淋巴结均阳性31／36,一侧淋巴结阳性,另一侧淋巴结阴性3／36,双侧淋巴结均阴性2／36。经1-13年随访,4例死亡,7例失访,25例存活,3例复发。结论分化型甲状腺癌行甲状腺切除联合同期双侧颈清术是安全的,关键是至少保留一侧颈内静脉,不要同时损伤双侧喉返神经和膈神经;对双侧颈淋巴结病理证实转移或临床判断转移（淋巴结明显肿大、质地偏硬或淋巴结为典型的紫葡萄颜色）的分化型甲状腺癌,均应行甲状腺切除联合同期双侧颈清;至少保留一个有血供的甲状旁腺;尽可能将甲状腺组织近全切或全切;应兼顾手术彻底性和机体功能保留。     

Carcinosarcoma of the parotid gland: Ultrasound and computed tomography findings

Carcinosarcoma is a rare tumour of the salivary gland. The ultrasound and CT appearances of a rapidly enlarging carcinosarcoma in the parotid are described. Both modalities revealed a 4-cm tumour with relatively benign features and no evidence of lymphadenopathy. Ultrasound showed a well-defined mass of homogeneous low echogenicity and posterior acoustic enhancement. Computed tomography showed a parotid mass of homogeneous attenuation similar to muscle, and homogeneous enhancement following contrast. The clue to the malignant nature of the lesion was a short indistinct superficial margin with tumour extension into the adjacent subcutaneous tissues.     

What is the Role of Diffusion Weigh Magnetic Resonance Imaging in Evaluation of Thyroid Nodules?

This study aimed to compare ultrasonography (US), contrast-enhanced computed tomography (CCT) of the neck, and diffusion-weigh magnetic resonance imaging (DW-MRI) in differentiating between benign and malignant nodules while approaching to thyroid nodules, and to estimate sensitivity and specificity of these methods. On thyroid US, echogenicity, calcification, presence/absence of halo, nodule size being larger/smaller than 20 mm, and nodule nature (cystic/solid nature) were evaluated. Findings on CCT of the neck were grouped according to the heterogeneity/homogeneity, presence/absence of enhancement, and intensity. On DW-MRI, diffusion restriction was evaluated. The findings of these tests were compared with postoperative histopathological findings, and specificity and sensitivity of the tests in differentiating malignant and benign nodules were assessed. The study included 38 patients (34 females, 4 males). The sensitivity and specificity of DW-MRI were 20 and 75 %, respectively. Presence of a >20 mm nodule in thyroid US had the highest sensitivity, whereas thyroid fine-needle aspiration biopsy (FNAB) had the highest specificity in detecting malignancy. The sensitivities and specificities of CCT of the neck and DW-MRI appeared relatively low. Evaluation of thyroid US findings together with thyroid FNAB findings provided high specificity and sensitivity and yielded better results than findings of CCT of the neck and DW-MRI.     

原发性甲状腺淋巴瘤的超声表现病理及其他影像学特征分析

  目的   探讨分析原发性甲状腺淋巴瘤超声、病理及其他影像学特征,加强临床医师对本病的深入认识。   方法   回顾性复习天津医科大学肿瘤医院放治的20例经手术病理证实的原发性甲状腺淋巴瘤。对该20例患者的临床、超声、病理及相关CT、MRI特征进行分析。   结果   20例原发性甲状腺淋巴瘤均为非霍奇金淋巴瘤（Non-Hodgkin lymphoma,NHL）。超声表现为12例甲状腺双叶受累,8例单侧叶受累。主要特征为:甲状腺弥漫性增大,双叶或单侧一叶回声减低,粗糙不均,内可见多个低回声团块,其中16例颈部伴有多发肿大淋巴结。5例表现肿物侵及气管,1例出现食管与气管同时受压。   结论   原发性甲状腺淋巴瘤的临床及影像学表现缺乏特异性,最后确诊依靠病理学。如临床发现颈部肿物短时间迅速增大,且超声表现为桥本氏甲状腺炎基础上的恶性征象,应考虑到淋巴瘤,及时做针吸或切取活检,以便临床选择恰当的治疗方案。       

甲状腺癌前哨淋巴结的临床及病理研究

目的 :探讨甲状腺癌前哨淋巴结的检测及其对颈淋巴结转移的预测价值。方法 :用手术中注射蓝染料的方法 ,对 30例甲状腺癌患者进行了手术中前哨淋巴结的临床研究 ,手术中取前哨淋巴结作快速冰冻病理 ,并与手术后常规石蜡切片病理对照 ,观察冰冻病理前哨淋巴结转移与常规病理颈淋巴结转移的相关性 ,及其对颈淋巴结转移的预测价值。手术后以抗角蛋白单抗行一步法免疫组化染色 ,并与常规HE染色对照。结果 :30例甲状腺癌中 2 7例成功的显示了前哨淋巴结 ,成功率 90 %。 2 7例前哨淋巴结平均每例 4枚 ,13例前哨淋巴结阳性的患者 ,其中 2例有前哨淋巴结以外的颈淋巴结转移 ;2例假阴性 ,前哨淋巴结对颈淋巴结转移的总的阳性预测值 86.7%。结论 :前哨淋巴结检测对甲状腺癌的颈淋巴结转移有重要的预测价值。     

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。     

超声造影联合弹性成像诊断甲状腺癌的价值分析

目的 探讨超声造影联合弹性成像诊断甲状腺癌的价值。方法 收集2014年3月至2015年12月经筛查的139例患者的168个甲状腺结节。根据检查方法分为：超声造影组52例患者共66个结节,弹性成像组56例患者共68个结节,超声造影和弹性成像联合组31例患者共34个结节,所有结节均行细针穿刺病理活检。分析结节的病理、常规彩超检查结果及各组的影像学表现情况,采用受试者工作特征曲线（ROC）分析各组在诊断甲状腺癌中的效能。结果 168个甲状腺结节均经病理组织学证实,其中良性112个,恶性56个。超声造影组良性41个,恶性25个;弹性成像组良性47个,恶性21个;联合组良性24个,恶性10个。超声造影联合弹性成像、弹性成像及超声造影诊断甲状腺结节良恶性的ROC曲线下面积分别为0.924、0.883、0.847;其灵敏性、特异性、准确性分别为70.0％、75.0％、73.0％,96.8％、94.4％、94.6％和90.0％、77.7％、80.0％。超声造影联合弹性成像的诊断效能优于弹性成像及超声造影单独使用。结论 超声造影联合弹性成像技术可大大提高甲状腺癌的诊断率,在临床上有较高的应用价值。     

Mucoepidermoid carcinoma arising in an intraparotid lymph node

A well-differentiated mucoepidermoid carcinoma that was confined to, and apparently arose within, an intraparotid lymph node is reported. Salivary gland ducts and acini often are found within intraparotid lymph nodes, and occasionally within extraparotid nodes. Salivary gland tumors, both benign and malignant, can develop within this ectopic salivary tissue. When a malignant salivary-gland-type neoplasm is found within an intraparotid or periparotid lymph node, the possibility exists that the tumor has arisen within the node and does not necessarily represent a metastasis from some other occult site.     

甲状腺乳头状癌超声表现与颈部淋巴结转移的相关性

目的:探讨甲状腺乳头状瘤超声表现与颈部淋巴结转移两者的相关性。方法:选取2013年3月到2014年3月收治的甲状腺乳头状瘤患者142例共160个结节。根据术后病理结果将入选患者分为颈部淋巴结转移组;没有发生颈部淋巴结转移的患者则为对照组。结果:转移组和对照组超声检查原发灶超声特征对比,转移组的钙化和毛刺对比对照组有统计学差异。患者的颈部淋巴结超声特征,转移组患者的囊变坏死、钙化、淋巴结边界等对比对照组有统计学差异（P<0.05）。采用Logistic回归分析对相关的危险因素进行分析,包括原发灶内钙化、淋巴结边界、淋巴结钙化以及淋巴结囊变坏死等4个方面,囊变坏死和淋巴结钙化与甲状腺乳头癌颈部淋巴结转移呈正相关。结论:甲状腺乳头状瘤超声结果显示有淋巴结囊变坏死以及淋巴结钙化是预测是否出现颈部淋巴转移的关键诊断指标。