超声诊断对甲状腺乳头状腺癌行中央区淋巴结清扫的临床应用

目的 探讨甲状腺乳头状腺癌行中央区淋巴结清扫患者采用超声诊断的准确率、灵敏度和特异度等情况,以指导临床诊疗.方法 对2011年6月至2015年12月本院进行中央区淋巴结清扫的甲状腺乳头状腺癌的440例住院患者作为观察对象,全部观察对象的诊断标准和手术方法均一致,且术前均通过超声对甲状腺非微小灶癌和甲状腺微小灶癌中央区淋巴结转移,探讨超声诊断在上述观察对象中的诊断价值.结果 超声诊断结果与金标准,其准确率为59.77％(263/440),其中微小灶癌诊断准确率为68.75％(143/208),非微小灶癌的诊断准确率为51.72％(120/232).超声对微小灶癌的漏诊率为60.27％(44/73),误诊率为15.56％(21/135),超声对非微小灶癌诊断的漏诊率为51.41％(73/142),误诊率为43.33％(39/90).超声对微小灶癌诊断的灵敏度为39.73％(29/73),特异度为84.44％(114/135),阳性预测值为58.00％(29/50),阴性预测值为32.30％(21/65).超声对非微小灶癌诊断的灵敏度为48.59％(69/142),特异度为56.67％(51/90),阳性预测值为63.89％(69/108),阴性预测值为38.24％(39/102).结论 超声结果提示中央区淋巴结超声阴性的患者,应结合患者自身因素,决定是否进行颈中央区淋巴结清扫,对于可能阳性的,宜行常规颈中央区淋巴结清扫.

Clinical application of ultrasound in diagnosis of papillary thyroid carcinoma line central lymph node dissection

Objective To investigate the accuracy,sensitivity,and specificity of ultrasound in the diagnosis of papillary thyroid carcinoma line central lymph node dissection and to guide clinical diagnosis and treatment.Methods 440 inpatients with central lymph node dissection of papillary thyroid carcinoma treated at our hospital from June,2011 to December,2015 were selected as observation objects.The diagnostic criteria and surgical methods were the same.The central lymph node metastasis of non-minimal and minimal foci thyroid cancer were diagnosed by ultrasonography and the diagnostic value was explore.Results Comparing gold standard,the accuracy of ultrasound was 59.77％ (263/440);the tiny stove cancer diagnostic accuracy was 68.75％ (143/208);the diagnosis of non-small cancer foci accuracy was 51.72％ (120 / 232).The ultrasound tiny stove cancer misdiagnosis rate was 60.27％ (44/73);the misdiagnosis rate was 15.56％ (21/135);the missed diagnosis rate of ultrasound for non-small foci was 51.41％ (73/142);the misdiagnosis rate was 43.33％ (39/90).The ultrasound diagnosis sensitivity to small foci cancer was 39.73％ (29/73);the specificity was 84.44％(114/135),the positive predictive value was 58％ (29/50),and the negative predictive value was 32.3％ (21/65).The ultrasound diagnosis sensitivity of non-small stove cancer was 48.59％ (69/142);the specificity was 56.67％(51/90);the positive predictive value was 63.89％ (69/108);and thee negative predictive value was 38.24％(39/102).Conclusions The ultrasound results suggest that central lymph node-negative patients should be combined with the patient's own factors when determining whether taking cervical central lymph node dissection;for positive patients,routine cervical central lymph node dissection should be taken.