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超声与CT检查在诊断甲状腺乳头状癌颈部淋巴结转移中的对比分析
引用本文:赵佳航,张艳,罗渝昆,唐杰,兰雨,何红莹,肖静,李文,汪龙霞.超声与CT检查在诊断甲状腺乳头状癌颈部淋巴结转移中的对比分析[J].中国医学科学院学报,2022,44(1):65-71.
作者姓名:赵佳航  张艳  罗渝昆  唐杰  兰雨  何红莹  肖静  李文  汪龙霞
作者单位:1.解放军医学院,北京 100853;2.中国人民解放军总医院第一医学中心超声诊断科,北京 100853
基金项目:国家自然科学基金(81901746)~~;
摘    要:目的 探讨超声与计算机断层扫描(CT)检查对甲状腺乳头状癌(PTC)颈部淋巴结转移(CLNM)的诊断效能。方法 选取2016年1月至2021年1月于中国人民解放军总医院行外科治疗且病理确诊为PTC的患者,术前均行超声及CT检查,回顾性分析两者对CLNM的诊断价值。结果 322例甲状腺乳头状癌中,242例出现颈部淋巴结转移,80例无转移。患者年龄(χ2=20.34,P<0.001)、原发灶大小(χ2=27.34,P<0.001)和颈侧区转移淋巴结最大径(χ2=4.30,P<0.001)在CLNM组与非CLNM组之间的差异有统计学意义。在中央区、颈侧区和中央区+颈侧区,超声诊断CLNM的灵敏度(χ2=82.26,P<0.001;χ2=114.01,P<0.001;χ2=82.26,P<0.001)、准确度(χ2=20.27,P<0.001;χ2=15.56,P<0.001;χ2=44.00,P<0.001)均高于CT,与超声联合CT间差异无统计学意义(P均>0.05);而超声诊断中央区和颈侧区CLNM的特异度低于CT(χ2=17.01,P<0.001;χ2=21.29,P<0.001)。受试者工作特征曲线分析显示,在中央区、颈侧区和中央区+颈侧区,超声诊断CLNM的曲线下面积(AUC)均高于CT(Z=2.99,P=0.003;Z=3.86,P<0.001;Z=4.47,P<0.001),与超声联合CT间差异无统计学意义(Z=1.87,P=0.062;Z=1.68,P=0.093;Z=1.61,P=0.107)。结论 超声与CT在中央区及颈侧区淋巴结的诊断中各具优势,总体上,超声对于CLNM的诊断效能优于CT。

关 键 词:甲状腺乳头状癌  淋巴结转移  超声  计算机断层扫描  诊断  
收稿时间:2021-05-08

Comparison between Ultrasonography and CT in Diagnosis of Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma
ZHAO Jiahang,ZHANG Yan,LUO Yukun,TANG Jie,LAN Yu,HE Hongying,XIAO Jing,LI Wen,WANG Longxia.Comparison between Ultrasonography and CT in Diagnosis of Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma[J].Acta Academiae Medicinae Sinicae,2022,44(1):65-71.
Authors:ZHAO Jiahang  ZHANG Yan  LUO Yukun  TANG Jie  LAN Yu  HE Hongying  XIAO Jing  LI Wen  WANG Longxia
Institution:1.Medical School of Chinese PLA,Beijing 100853,China;2.Department of Ultrasound,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China
Abstract:Objective To evaluate the efficacy of ultrasound and computed tomography (CT) in diagnosing cervical lymph node metastasis (CLNM) of papillary thyroid carcinoma (PTC). Methods The patients with PTC treated by surgery in the Chinese PLA General Hospital from January 2016 to January 2021 were selected for analysis.All the patients underwent preoperative ultrasound and CT examinations,the diagnostic values of which for CLNM were retrospectively analyzed. Results A total of 322 PTC patients were enrolled in this study,including 242 with CLNM and 80 with non-CLNM.The CLNM group and non-CLNM group had significant differences in age,tumor size,and maximum size of lateral CLNM (χ2=20.34,27.34,and 4.30,respectively,all P<0.001).For the central compartment,lateral compartment,and overall compartment,ultrasound diagnosis showed higher sensitivity (χ 2=82.26,P<0.001;χ2=114.01,P<0.001;χ2=82.26,P<0.001) and accuracy (χ2=20.27,P<0.001;χ2=15.56,P<0.001;χ2=44.00,P<0.001) than CT,and had no significant differences from ultrasound combined with CT (all P>0.05).However,ultrasound diagnosis had lower specificity than CT (χ2=17.01,P<0.001;χ2=21.29,P<0.001) in the central compartment and lateral compartment.Receiver operating characteristic curve analysis showed that in the central compartment,lateral compartment,and overall compartment,ultrasound diagnosis had larger AUC than CT (Z=2.99,P=0.003;Z=3.86,P<0.001;Z=4.47,P<0.001) and had no significant difference from ultrasound combined with CT (Z=1.87,P=0.062;Z=1.68,P=0.093;Z=1.61,P=0.107). Conclusions Ultrasound and CT have their own advantages in the diagnosis of central and lateral CLNM.In general,ultrasound has better performance than CT in the diagnosis of CLNM.
Keywords:papillary thyroid carcinoma  lymph node metastasis  ultrasound  computed tomography  diagnosis  
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