颈部淋巴结内囊性变在甲状腺乳头状癌转移诊断中的作用

目的:观察高分辨率超声仪在诊断甲状腺乳头状癌颈部淋巴结转移中的作用,并评价颈部淋巴结内囊性变作为甲状腺乳头状癌转移的特征性改变及其特异性和敏感性。方法:回顾性分析87例颈部淋巴结异常的患者,所有患者均曾行灰阶及彩色多普勒检查、超声引导细针穿刺活检和/或术后组织病理学检查。结果:所有患者超声显示淋巴结异常,在69%甲状腺乳头状癌患者的转移淋巴结中可见囊性变。而在非甲状腺乳头状癌患者的转移淋巴结中仅有2例可见此现象。颈部淋巴结内部出现囊性变作为甲状腺乳头状癌转移的超声特征性改变,其敏感度为69%,特异度为96.6%,阳性预测值为90.9%,阴性预测值为83.6%,准确度为87.4%。结论:颈部淋巴结内出现囊性变高度提示甲状腺乳头状癌转移。

The US features of cervical lymph node with cystic change in the diagnosis of metastatic papillary thyroid carcinoma

Objective: To investigate the usefulness of high-resolution ultrasonography and assess the accuracy of cystic change within cervical lymph node as a criterion in diagnosing metastases from papillary thyroid carcinoma. Methods: Sonograms of abnormal cervical lymph nodes in 87 patients were reviewed retrospectively. All patients had undergone sonographic examination, ultrasound-guided fine-needle aspiration(FNA) and 40 patients had surgical excision. Result: Abnormal sonographic features were present in the lymph nodes of all the 87 patients. Cystic changes within lymph node were showed in 20(69%) of 29 patients with papillary thyroid cancer. This feature was found in only 2 of the other 58 patients, in whom FNA revealed either metastasis from other malignancy(38 patients) or benign reactive lymphadenopathy(20 patients). The results yielded a 69% sensitivity, 96.6% specificity, 90.9% positive predictive value, 83.6% negative predictive value, and 87.4% accuracy for this criterion. Conclusion: Cystic changes within a cervical lymph node are highly suggestive of metastatic papillary thyroid carcinoma.