超声检查在诊断甲状腺乳头状癌Ⅲ、Ⅳ区及Ⅵ区淋巴结转移的临床意义

目的探讨超声检查在诊断甲状腺乳头状癌Ⅲ、Ⅳ、Ⅵ区淋巴结转移的准确性及临床意义。方法回顾性分析2012年2月14日-2013年4月22日我院普外三区185例甲状腺乳头状癌患者行Ⅲ、Ⅳ区（同组）及Ⅵ区双侧淋巴结清扫后淋巴结转移情况。185例术前均行超声检查，按照颈部淋巴结阳性（A组）和阴性（B组）分组。每组再按超声所报肿瘤最大长径分为A1、B1≤0．5em，A2〉0．5cm、B2≤1．0em，A3、B3〉1．0em三组。每组再按淋巴结Ⅲ、Ⅳ区及Ⅵ区分为A11、A12、B11、B12，A21、A22、B21、B22、A31、A32、B31、B32。分别对A11与B11、A12与B12、A21与B21、A22与B22、A31与B31、A32与B32的术后淋巴结转移率进行统计分析。结果A组83例，B组102例；A1：21例；A2：28例；A3：34例；B1：27例；B2：23例；B3：52例。A11阳性6例，A12阳性8例；A21阳性9例，A22阳性8例；A31阳性18例，A32阳性23例；B11阳性1例，B12阳性2例；B21阳性1例，B22阳性11例；B31阳性23例，B32阳性39例。A11与B11、A12与B12、A21与B21差异有统计学意义。结论无论术前超声诊断颈淋巴结是否为阳性，甲状腺乳头状癌颈淋巴结转移均可发生。当甲状腺肿瘤最大长径≤0．5cm时，超声可对Ⅲ、Ⅳ区及Ⅵ区淋巴结阳性者做出转移诊断；当甲状腺肿瘤最大长径〉0．5cm且≤1．0cm时，超声可对Ⅵ区淋巴结阳性者做出转移诊断；当甲状腺肿瘤最大长径〉1．0cm时，超声对Ⅲ、Ⅳ区及Ⅵ区淋巴结转移诊断不明。

Role of ultrasonography in clinical diagnosis of lymphatic metastasis of papillary thyroid carcinoma in regions III,IV and VI

Objective To study the accuracy and clinical significance of ultrasonography in diagnosis of lymphatic metastasis of papillary thyroid carcinoma （PTC） in regions III , IV and VI . Methods Lymphatic metastases in 185 patients with PTC in regions II , IV and VI who underwent ultrasonography and bilateral clearance of lymph nodes in our hospital from February 14, 2012 to April 22, 2013 were retrospective analyzed. The patients were divided into group A and group B according to their positive or negative cervical lymph nodes. Each group was further divided into A1 and B1 ≤ 0.5 cm group, A2 〉 0.5 cm and B2 〈 1.0 cm group, A3 and B 3 〉 1 .0 cm group according to their tumor diameter and into A 11, A 12, B 11, B 12, A21, A22, B21, B22, A31, A32, B31 and B32 groups according to the number of lymph nodes in regions III, IV and VI .Lymphatic metastasis of A11 and B 11, A12 and B 12, A21 and B21, A22 and B22, A31 and B31, A32 and B32 was analyzed after operation. Results Lymphatic metastasis was found in group A （n=83）, group B （n=102）, group A1 （n=21）, group A2 （n=28）, group A3 （n=34）, group B1 （n=27）, group B2（n=23）, group B3 （n=52）. Positive All, A12, A21, A22, A31, A32, Bll, B12, B21, B22, B31 and B32 were detected in 6, 8, 9, 8, 18, 23, 1, 2, 1, 11,23 and 39 patients, respectively, and were significantly different from positive B 11, A 12 and B 12, A21 and B21. Conclusion Cervical lymphatic metastasis of papillary thyroid carcinoma can occur whether preoperative ultrasonography shows positive cervical lymph nodes. When the maximum diameter of PTC is 〈 0.5 cm, ultrasonography can show its lymphatic metastasis in regions III, IV and VI . When the maximum diameter of PTC is 〉 0.5 cm and ≤ 1.0 cm, ultrasonography can display its lymphatic metastasis in region VI . When the maximum diameter of PTC is 〉 1.0 cm, ultrasonography cannot reveal its lymphatic metastasis in regions III , IV and VI .