彩色超声、FNA-C、FNA-Tg在诊断甲状腺乳头状癌（PTC）颈部淋巴结转移中的价值

  目的  探讨颈部淋巴结彩色超声征象（CDU）、淋巴结细针穿刺细胞学检查（FNA-C）、淋巴结细针穿刺洗脱液中甲状腺球蛋白含量（FNA-Tg）在诊断甲状腺乳头状癌（PTC）颈部淋巴结转移中的价值。  方法  回顾性分析甲状腺乳头状癌（PTC）患者颈部淋巴结CDU、FNA-C、FNA-Tg、术前血清Tg、术后病理结果，并分析其特异性和阳性预测率。确定FNA-Tg的受试者工作特征(ROC)曲线和最佳诊断阈值。然后分析术前血清Tg、促甲状腺激素(TSH)、血清Tg抗体(TGAB)与淋巴结FNA-Tg的相关性。  结果  CDU典型转移超声征象的淋巴结中，FNA-Tg的准确率为100%；CDU非典型转移超声征象（淋巴结皮质厚度不均匀，皮质厚度≥2 mm）的淋巴结，FNA-Tg准确率为88.9%,优于CDU和FNA-C；淋巴结FNA-Tg诊断PTC颈淋巴结转移的阈值为2.57 ng/mL；淋巴结FNA-Tg与血清Tg、TGAB无相关性(P > 0.05)，而与TSH有相关性(P < 0.05)。  结论  CDU显示颈部淋巴结典型转移征象PTC患者结合CDU征象、淋巴结FNA-C、FNA-Tg，可准确诊断甲状腺乳头状癌（PTC）颈部淋巴结转移。CDU显示颈部淋巴结非典型转移征象（皮质厚度不均匀≥2 mm）的PTC患者应引起注意，淋巴结检查FNA-C和FNA-Tg可明显提高诊断率，形成临床治疗PTC患者颈淋巴转移的重要依据。

Value of Color Doppler Ultrasonography,Fine Needle Aspiration Cytology,and the Level of Thyroglobulin in the Diagnosis of Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma

  Objective  To explore the value of color Doppler ultrasonography （CDU） signs, fine needle aspiration cytology （FNA-C） of lymph nodes, and the level of thyroglobulin in lymph node fine needle aspiration eluate （FNA-Tg） in the diagnosis of cervical lymph node metastasis of papillary thyroid carcinoma （PTC）.   Methods  Firstly, CDU signs of cervical lymph nodes, FNA-C, FNA-Tg level, preoperative serum Tg level, and postoperative pathological results of patients with PTC were retrospectively analyzed and the specificity and positive prediction rate of them were also analyzed. Then, the receiver operating characteristic （ROC） curve and the optimal diagnostic threshold of FNA-Tg levels were determined. After that, the correlation between preoperative serum Tg, thyroid-stimulating hormone （TSH）, serum Tg antibody （TGAB） and lymph node FNA-Tg level were analyzed.   Results   As a result, in patients with typical ultrasound signs of cervical lymph node metastasis, the diagnostic rate of FNA-Tg was 100%, which is better than CDU and FNA-C. the cortical thickness of cervical lymph nodes is uneven and is ≥ 2mm, the diagnostic rate of FNA-Tg was 88.9%. The threshold value of FNA-Tg level in lymph nodes for diagnosing cervical lymph node metastasis of PTC was 2.57 ng/ml. There was no correlation between lymph node FNA-Tg and serum Tg level, serum TGAB （P > 0.05）, while there was a correlation between lymph node FNA-Tg and TSH （P < 0.05）.   Conclusions  For PTC patients with typical signs of cervical lymph node metastasis showed by CDU, the combination of CDU signs, lymph node FNA-C and FNA-Tg can accurately diagnose cervical lymph node metastasis. Attention should be paid to PTC patients with atypical signs of cervical lymph node metastasis （uneven cortical thickness ≥ 2 mm） showed by CDU, Lymph node lymph node FNA-C and FNA-Tg can significantly improve the diagnostic rate and form an important basis for clinical treatment of cervical lymph node metastasis in PTC patients.