薄层CT在甲状腺乳头状癌中央区淋巴结转移术前评估中的作用

目的评价甲状腺乳头状癌中央区淋巴结转移的CT特点及探讨CT在甲状腺乳头状癌中央区淋巴结转移术前评估中的作用。方法回顾性分析149例甲状腺乳头状癌行中央区淋巴结清扫患者的临床资料,术前均行颈部CT平扫+增强,并与术后病理比较。结果 149例甲状腺乳头状癌患者中,CT可见的淋巴结共350枚。病理诊断有中央区淋巴结转移的99例患者可见292枚淋巴结,其中13枚有钙化,200枚有包膜外侵犯,146枚有淋巴结强化,48枚有坏死,其淋巴结短径和长径的平均值分别为6.5 mm和8.5 mm。病理诊断无中央区淋巴结转移的50例患者中,33例可见58枚淋巴结,无一枚有钙化,7枚有包膜外侵犯,9枚有淋巴结强化,8枚有坏死,其淋巴结短径和长径的平均值分别为4.4 mm和6.1 mm。CT诊断甲状腺乳头状癌中央区淋巴结有无转移的灵敏度为100%,特异度为34.0%。结论有无钙化、包膜外侵、强化及坏死及淋巴结的长短径是CT诊断甲状腺乳头状癌中央区淋巴结转移的重要指标,严格应用这些指标对甲状腺乳头状癌的患者进行术前评估,对诊断有无中央区淋巴结转移有一定帮助。

Diagnostic ability of CT for evaluating metastatic central lymph nodes in patients with papillary thyroid cancer

Objective To assess the character and the diagnostic ability of CT for evaluating metastatic central lymph nodes in patients with papillary thyroid cancer.Methods 149 patients who subsequently underwent central neck dissection for papillary thyroid cancer were studied retrospectively.All the patients underwent CT for preoperative evalution.The results of the review of the preoperative CT were compared with the histopathologic results.Result Among 149 cases with papillary thyroid carcinoma,350 lymph nodes are detected in the CT scan.,292 of which belong to the 99 patients proven to have metastatic central lymph nodes.Of these metastatic central lymph nodes,13 are seen with calcification,200 with extranodal extension,146 with enhancement,and 48 with central necrosis or cystic change,the average of short axis and long axis are 6.5 mm and 8.5 mm respectively.Among 50 cases who have no lymph node metastasis in central district,58 lymph nodes are seen in 33 patients,none of which is seen with calcification,7 with extranodal extension,9 with enhancement,and 8 with central necrosis or cystic change.The average of short axis and long axis are 4.4 mm and 6.1 mm respectively.The sensitivity and specificity for CT diagnosis of lymph node metastasis in papillary thyroid carcinoma are 100%,and 34.0% respectively.Conclusion The calcifications,extranodal extension,enhancement,central necrosis or cystic change,the short axis and long axis can be considered as major CT criteria of LN malignancy.These items could be applied strictly as pre-operative evaluation for patients with PTC,which are helpful to diagnose the central lymph nodes metastasis.