超声对甲状腺乳头状癌颈部淋巴结转移规律及特点的评价

目的:探讨超声对甲状腺乳头状癌（papillary thyroid cancer，PTC）颈部淋巴结转移规律及特点的价值。方法:回顾性分析 91例（112侧）颈部阳性淋巴结（cN+）PTC患者的声像图特征，分为术前颈部淋巴结触诊阳性患者61侧和术前颈部触诊阴性而超声提示为颈淋巴转移患者51侧两组。记录术中转移淋巴结的数量及在Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ 区的分布。结果:PTC颈部转移性淋巴结的超声特点以类圆形及淋巴门消失多见，内部呈低回声伴钙化、囊性变或呈高回声。91例患者中21例双侧颈转移占23.1％，112侧颈清扫标本中89侧（79.5％）为多分区转移；颈转移淋巴结在Ⅱ区57.1％（64/112）、Ⅲ区56.3％（63/112）、Ⅳ区61.6％（69/112）、Ⅵ区67.9％（76/112）。Ⅴ区仅占18.8％（21/112），差异有统计学意义（P<0.001）。术前超声检查可以发现45.5％（51/112）的颈部触诊漏诊的颈部淋巴转移。结论:PTC的颈部淋巴转移可以多区分布，其中Ⅱ、Ⅲ、Ⅳ、Ⅵ区为主要的转移部位，Ⅵ区相对较高，颈部转移性淋巴结呈类圆形及淋巴门消失多见，内部呈低回声伴钙化、囊性变或呈高回声。超声在PTC颈淋巴转移的诊断中具有重要的价值。

Evaluation of cervical lymph node metastasis patterns and features in papillary thyroid cancer patients using ultrasound

Objective:To discuss the value of ultrasound(US）in detecting the patterns and features of cervical lymph node metastasis(LNM）in patients with papillary thyroid cancer (PTC).Methods:We retrospectively reviewed ultrasonic images of 91 patients(112 sides）with positive cervical lymph nodes(cN+）in PTC who had undergone preoperative US and palpation.Of 112 sides，61 sides of palpation were positive，and the left 51 sides of palpation were negative while the US results were positive.The number of LNM and distribution in zone Ⅱ，zone Ⅲ，zone Ⅳ，zone V and zone Ⅵ were recorded according to operation.Results:The ultrasonic features of LNM in PTC with quasi-circular echoes and disappeared lymphatic hilum could be seen more frequently.The interior of nodes presented hypoechoic with calcification，cystic change or hyperechoic.Of 91 patients，number of bilateral cervical metastasis was 21 accounted for 23.1%.Of 112 sides of cervical dissection specimens，89 sides belonged to multi-zone metastasis.The number of cervical LNM accounted for 57.1％(64/112）in zone Ⅱ，56.3％(63/112）in zone Ⅲ，61.6％(69/112） in zone Ⅳ，67.9％(76/112） in zone Ⅵ and only 18.8％(21/112） in zone V.There was significant difference statistically(P<0.001).45.5% (51/112）of cervical LNM of missed diagnosis by palpation could be found by preoperative ultrasound.Conclusion:LNM in PTC could distribute in several zones simultaneously，which mainly distributed among zone Ⅱ，zone Ⅲ，zone Ⅳ and especially zone Ⅵ.The ultrasound of LNM presented quasi-circular echoes and disappeared lymphatic hilum more frequently.The interior of nodes presented hypoechoic with calcification，cystic change or hyperechoic.Ultrasound had an important value in the diagnosis of cervical LNM in PTC.