高频超声引导下细针抽吸活检结合细针抽吸洗脱液甲状腺球蛋白检测对甲状腺乳头状癌术后颈部淋巴结转移的诊断价值  

Clinical value of high frequency ultrasound guided fine needle aspirates（FNA） and FNA-thyroglobulin detection for diagnosing cervical metastatic lymph nodes in patients underwent thyroidectomy for papillary thyroid carcinoma

作　　者：许立龙[1] 李世岩[1] 徐海珊[1] 赵博文[1] 高力[2] 张慕蕊[3] 翁萌炜[4] 

机构地区：[1]浙江大学医学院附属邵逸夫医院超声科浙江大学邵逸夫临床医学研究所,杭州310016 [2]浙江大学医学院附属邵逸夫医院头颈外科,杭州310016 [3]浙江大学医学院附属邵逸夫医院病理科,杭州310016 [4]浙江大学医学院附属邵逸夫医院检验科,杭州310016

出　　处：《中华超声影像学杂志》2014年第8期679-682,共4页Chinese Journal of Ultrasonography

摘　　要：目的 探讨高频超声引导下细针抽吸（FNA）细胞学结合细针抽吸洗脱液甲状腺球蛋白（FNA-Tg）检测对甲状腺乳头状癌术后颈部淋巴结转移的诊断价值.方法 回顾性分析甲状腺乳头状癌术后,临床随访中超声检查怀疑有颈部淋巴结转移患者65例,共79个异常淋巴结在高频超声引导下行FNA细胞学检查,同时以生理盐水冲洗细针针管,化学发光免疫测定法检测洗脱液中的甲状腺球蛋白（Tg）含量,所有淋巴结均经手术切除（包括颈部淋巴结清扫术）,并送组织病理学检查.结果 65例患者中,共检出79个可疑转移性淋巴结并对其进行细针穿刺,经术后组织病理证实的淋巴结转移阳性者共62个,阴性者17个.FNA细胞学检查判断为阳性淋巴结者54个,阴性者25个,FNA细胞学检查诊断颈部的淋巴结转移的准确性89.87％ （71/79）,敏感性87.10％（54/62）,特异性100％（17/17）,阳性预测值100％（54/54）,阴性预测值68.00％（17/25）.洗脱液FNA-Tg检测判定阳性淋巴结65个,阴性淋巴结14个.洗脱液FNA-Tg诊断颈部淋巴结转移的准确性96.20％ （76/79）,敏感性100％（62/62）,特异性82.35％（14/17）,阳性预测值95.38％（62/65）,阴性预测值100％（14/14）.FNA细胞学检查与FNA-Tg检测诊断甲状腺乳头状癌颈部淋巴结转移的准确率比较,差异无统计学意义（x2=1.454,P=0.228）.FNA细胞学检查假阴性的8个淋巴结在结合FNA-Tg检测结果后均获得了正确诊断.结论 FNA细胞学检查与FNA-Tg浓度检测均为甲状腺乳头状癌术后诊断淋巴结转移的有效手段.二者可以相互补充,早期、准确判定甲状腺乳头状癌术后颈部淋巴结转移情况.Objective To investigate the diagnositc value of high frequency ultrasound guided fine needle aspirates （FNA） and thyroglobulin （Tg） in fine-needle aspirate fluid （FNA-Tg） measurement for detecting metastatic lymph nodes in patients underwent thyroidectomy for papillary thyroid carcinoma （PTC）.Methods Sixty-five patients with 79 suspected metastatic lymph nodes were retrospective analysis in this study.FNA for suspected lymph nodes was performed guided by high frequency ultrasound and FNATg was measured.The histopathologic diagnosis for all of the suspected lymph nodes was obtained after lymphadenectomy.Results By histopathologic diagnosis,62 lymph nodes were positive metastasis,while 17 were negative metastasis.Fifty-four lymph nodes were diagnosed as positive metastasis and 25 as negative metastasis by FNA.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of FNA for assessing cervical metastatic lymph nodes from PTC were 89.87％ （71/79）,87.10％ （54/62）,100％ （17/17）,100％ （54/54） and 68.00％ （17/25）,respectively.Sixty-five lymph nodes were diagnosed as positive metastasis and 14 as negative metastasis by FNA-Tg.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of FNA-Tg were 96.20％ （76/79）,100％ （62/62）,82.35％ （14/17）,95.38％ （62/65） and 100％ （14/14）,respectively.There was no significant difference between FNA and FNA-Tg for evaluating cervical metastatic lymph nodes from PTC （x2 =1.454,P =0.228）.Eight positive metastatic lymph nodes which were missed by FNA were corrected diagnosed by FNA-Tg measurement.Conclusions Both FNA and FNA-Tg are effective methods for assessing cervical metastatic lymph nodes from PTC postoperatively,and these two methods could be combined for early and accurate evaluating the lymph nodes state.

关 键 词：超声检查 甲状腺肿瘤 活组织检查 细针 淋巴转移 甲状腺球蛋白 

分 类 号：R736.1[医药卫生—肿瘤]