高频超声在评价甲状腺癌颈部淋巴结转移中的价值分析

【摘要】目的探讨高频超声在甲状腺癌颈部淋巴结转移中的诊断价值。方法选取术前经超声检查的29例甲状腺癌患者，分析颈部淋巴结超声二维显像及e—Flow血流成像特点，术后应用免疫组织化学技术计数淋巴结微血管密度（microvessel density，MVD），分析血管组织形态，并将超声显像特点与病理结果进行对照分析。结果29例患者经病理证实有转移性淋巴结102个，非转移性淋巴结32个。83个（81．4％）转移性淋巴结纵横比〈2；81个（79．4％）转移性淋巴结边界不清；76个（74．5％一）转移性淋巴结内回声不均匀；41个（40．2％）内部看见点状高回声，经病理证实为钙化或胶体析出；12个（11．8％）甲状腺癌淋巴结转移内部看见囊性变。转移性淋巴结内部彩色血流以Ⅱ、Ⅲ级为主；非转移性淋巴结内部彩色血流以0、I级为主。2种淋巴结组上述指标间差异有统计学意义（P〈0．05）。2组MVD值比较，转移性淋巴结组MVD值高于非转移性淋巴结组，差异有统计学意义（P〈0．05）；转移性淋巴结的血流分级与CD34、CDl05标记的转移性淋巴结形态比较，低血流分级（0、I级）以点状、线状血管为主，而高血流分级（Ⅱ、Ⅲ级）以带状、网状血管为主，统计分析显示差异有统计学意义（P〈0．05）。结论高频超声二维显像结合e-Flow超声成像技术对于鉴别甲状腺癌颈部转移性淋巴结与非转移性淋巴结具有较高的诊断价值。

VALUE OF HIGH FREQUENCY ULTRASOUND IN EVALUATION OF METASTASIS OF CERVICAL LYMPH NODES IN THYROID CARCINOMA

Objective To the cervical lymph node metastasis investigate the diagnostic value of high frequency ultrasonography in of thyroid carcinoma. Methods The study inCluded preoperative ultrasonographic data of 29 thyroid cancer patients confirmed by surgery. Two-dimensional sonographic features and e-flow imaging features of cervical lymph node were compared with post-operative pathological results. Immunohistochemical techniques were applied to mark tumor microvessels, then statistically analyze microvessel density （MVD）, and the relationship between MVD, vascular morphology uhrasonil image. Results Pathological results showed that 102 lymph nodes were metastatic and 32 were non metastatic. 83 metastatic lymph nodes（ 81.4% ） were found the with longitudinal/transverse ratio 〈2,81 metastatic lymph nodes（79.4% ） were poorly circumscribed. 76 metastatic lymph nodes（74.5% ） were with heterogeneity internal echo, 41 metastatic lymph nodes （40. 2%） were with hyperechoic punctuations （calcification or colloidal precipitation）, 12 metastatic lymph nodes （11.8%） were with cystis degeneration. Flow grade Ⅱ and Ⅲ were predominant in the metastatic lymph nodes group, flow grade 0, I for non metastatic lymph nodes group. The differences between the two groups were significant （ P 〈 0. 05 ）. In case of MVD value comparison, thyroid cancer metastatic lymph nodes group had a higher MVD value than the non metastatic lymph nodes group, and statistical analysis showed a statistical significance （P 〈 0.05 ）. By comparing metastatic lymph nodes, flow grade with CD34, CD105 marked metastatic lymph nodes vascular morphology,low-flow grade （0, I level） was mainly in point and line blood vessels,high-flow grade （ II ,Ⅲ ） was mainly in ribbon and mesh blood vessels, which showed a statistical difference （P 〈 0.05）. Conclusion 2D ultrasound imaging and e-flow imaging techniques of high frequency ultrasonography has great diagnostic value for distinguishing cervical metastatic lymph nodes from non metastatic lymph nodes in thyroid cancer.