超声检查在分化型甲状腺癌术后患者诊断颈部淋巴结转移中的应用

目的探讨分化型甲状腺癌(differentiated thyroid cancer,DTC)术后颈部淋巴结转移的超声声像图特征,评估超声检查的诊断性特征,提高其诊断率。方法 123例DTC术后患者,经细针穿刺细胞学或手术病理等检查结果证实的颈部淋巴结转移40例(观察组),未转移83例(对照组),从5个方面比较2组间治疗前颈部淋巴结超声声像图特征:淋巴结长径/短径之比、微小钙化、淋巴门结构是否存在、彩色多普勒血流显像情况、囊性或液化改变。组间计数资料比较采用χ~2检验,并分析超声诊断的灵敏度、特异性、准确性、特异度、阳性及阴性预测值。结果观察组中33例淋巴结长短径之比<2,对照组9例;观察组中微小钙化17例,对照组2例;淋巴门观察组中7例显示不清,对照组中2例出现显示不清;彩色血流观察组中12例出现血流丰富,对照组中出现3例;观察组4例出现囊性或液化区,对照组1例。此5种声像图表现的阳性比例分别为82.5%、42.5%、17.5%、30.0%及10.0%;颈部转移淋巴结患者超声下长径/短径<2明显高于未发生颈部淋巴结转移患者,差异均有统计学意义(均P<0.05)。超声诊断DTC术后颈部淋巴结转移的灵敏度、特异度、准确性、阳性预测值及阴性预测值分别为82.5%、74.7%、77.2%、61.1%及89.9%。结论超声检查对DTC术后颈部淋巴结转移诊断具有较高的灵敏度及特异度,可通过多种特征性的超声表现来诊断颈部淋巴结转移。

Value of ultrasound in evaluation of metastasis of cervical lymph nodes in differentiated thyroid cancer after operation

Objective To investigate the ultrasonographic features of cervical lymph node metastasis after differentiated thyroid cancer (DTC), evaluate the diagnostic features of ultrasonography, and improve the diagnostic rate. Methods A total of 123 patients with DTC were enrolled in this study. Forty cases of cervical lymph node metastasis confirmed by fine needle aspiration cytology or surgical pathology(observation group), 83 cases without metastasis(control group), compared between the two groups. Ultrasound sonographic features of cervical lymph nodes before treatment: long-term/short-diameter ratio of lymph nodes, microcalcification, presence of lymphatic portal structures, color Doppler flow imaging, cystic or liquefaction changes. The comparison between the group count data was analyzed by χ2, and the sensitivity, specificity, accuracy, specificity, positive and negative predictive value of the ultrasound diagnosis were analyzed. Results In the observation group, the ratio of length to diameter of 33 lymph nodes was <2, and 9 cases in the control group.In the observation group, 17 cases were microcalcification, 2 cases in the control group, and 7 cases in the lymphatic observation group were unclear. Two cases showed unclear; 12 cases in the color flow observation group showed abundant blood flow, and 3 cases in the control group. There were 4 cases in the cystic or liquefied area observation group and 1 case in the control group. The positive proportions of the five sonograms were 82.5%, 42.5%, 17.5%, 30.0%, and 10.0%, respectively. The long-term/short-diameter <2 in the cervical lymph node metastasis was significantly higher than that in the cervical lymph nodes. The patients with metastasis were statistically significant(P<0.05). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of cervical lymph node metastasis after DTC were 82.5%, 74.7%, 77.2%, 61.1% and 89.9%. Conclusion Ultrasonography has high sensitivity and specificity for the diagnosis of cervical lymph node metastasis after DTC.It can diagnose cervical lymph node metastasis through various characteristic ultrasound findings.