超声联合血清Tg、SPECT/CT诊断分化型甲状腺癌术后颈部淋巴结转移

目的 探讨高频超声结合血清甲状腺球蛋白（Tg）、SPECT/CT诊断分化型甲状腺癌（DTC）术后颈淋巴结转移的价值。方法 收集185例经手术病理证实的 DTC患者，于¹³¹I治疗前常规行甲状腺床区及颈部淋巴结超声扫查，并检查血清Tg；¹³¹I治疗1周后行¹³¹I全身扫描，SPECT颈部断层与同机CT图像融合；结合各项检查、淋巴结穿刺活检及临床随访等确定转移淋巴结。结果 共确诊60例DTC颈部转移，其中超声发现转移淋巴结41例（41/60，68.33%），SPECT/CT发现45例（45/60，75.00%），血清Tg阳性25例（25/60，41.67%）。超声与SPECT/CT对颈部淋巴结转移的检出率差异无统计学意义（P>0.05），与血清Tg差异有统计学意义（P<0.01）。超声诊断颈淋巴结转移符合率为78.92%（146/185），SPECT/CT诊断符合率为82.70%（153/185），超声联合血清Tg及SPECT/CT的诊断符合率为88.11%（163/185）。结论 超声对于诊断DTC术后颈淋巴结转移有重要价值，结合血清TG、SPECT/CT有助提高颈淋巴结转移检出率。

Ultrasonography combined with serum Tg and SPECT/CT in diagnosis of postoperative lymph node metastasis of differentiated thyroid carcinoma

Objective To investigate the diagnostic value of ultrasonography combined with serum thyroglobulin (Tg) and SPECT/CT in diagnosis of postoperative lymph node metastasis of differentiated thyroid carcinoma (DTC). Methods Totally 185 DTC patients were enrolled. Ultrasonography examination was performed and serum Tg was measured before ¹³¹I treatment. ¹³¹I whole body scan was made after ¹³¹I treatment. Combining serum Tg, SPECT/CT, lymph node biopsy and clinical follow-up of patients, cervical lymph node metastases were identified. Results Cervical lymph node metastases were detected by ultrasonography in 41 cases (41/60, 68.33%), and by SPECT/CT in 45 (45/60, 75.00%) cases. Among all 60 patients with cervical lymph node metastases,serum Tg was positive in 25 patients (25/60, 41.67%). There was no difference between ultrasonography and SPECT/CT (P>0.05), while significant difference was found between ultrasonography and Tg (P<0.01) in detecting cervical lymph node metastases. The accordance rate of ultrasonography for diagnosing lymph node metastases was 78.92% (146/185), of SPECT/CT was 82.70% (153/185), while of combination of the above methods was 88.11%(163/185). Conclusion Ultrasonography has great diagnostic value for postoperative lymph node metastasis of differentiated thyroid carcinoma. Combination of ultrasonography, SPECT/CT and serum Tg can improve diagnostic accuracy.