CT在评估甲状腺乳头状癌中央组淋巴结转移中的价值  

Value of CT in diagnosing central lymph node metastasis of papillary thyroid carcinoma

作　　者：林启强 韩志江[2] 舒艳艳[3] 陈文辉[2] 

机构地区：[1]浙江省苍南县第二人民医院放射科,浙江苍南325802 [2]杭州市第一人民医院放射科,浙江杭州310006 [3]杭州市萧山区第一人民医院放射科,浙江杭州311200

出　　处：《中国临床医学影像杂志》2015年第3期162-165,205,共5页Journal of China Clinic Medical Imaging

基　　金：2013苍南县科技计划项目(2013S46);2012杭州市卫生科技计划项目(2012A020);2013杭州市重大科技创新专项项目(20131813A08)

摘　　要：目的:探讨CT在评估甲状腺乳头状癌(Papillary thyroid carcinoma,PTC)中央组淋巴结转移中的价值。方法:回顾经病理证实的559例625个PTC患者中央组淋巴结的CT资料,统计CT评估中央组淋巴结转移阳性和阴性的符合率,观察簇状淋巴结、高强化和最小径/最大径≥1/2、囊变和微钙化在中央组淋巴结转移中的分布,分析桥本甲状腺炎在簇状淋巴结组中的分布。结果:625个中央组中,218个中央组淋巴结转移,407个中央组无淋巴结转移,CT评估中央组淋巴结转移阳性和阴性的符合率分别为59.2%(129/218)和91.6%(373/407)。簇状淋巴结、高强化、最小径/最大径≥1/2、囊变更常见于中央组淋巴结转移组(P<0.05),其敏感性、特异性、阳性预测值和准确度分别为31.7%,93.5%,71.1%,72.7%;84.1%,66.7%,86%,79%;95.5%,44.4%,80.7,80.6%;2.5%,100%,100%,67.2%。4种CT征象联合时,其敏感性、特异性、阳性预测值和准确度分别59.2%、88.2%、72.9%和78.1%。微钙化仅见于2个中央组淋巴结转移组中。114个簇状淋巴结组中,31个合并桥本甲状腺炎,其中22个误诊为淋巴结转移。结论:CT在评估PTC中央组淋巴结转移中具有重要价值,簇状淋巴结、高强化和最小径/最大径≥1/2、囊变有助于淋巴结转移的诊断,桥本甲状腺炎的中央组淋巴结可呈簇状,易误诊为淋巴结转移,需引起临床关注。Objective： To investigate the value of CT in diagnosing central lymph node metastasis of papillary thyroid car- cinoma（PTC）. Methods： CT data of 625 central lymph nodes with pathological diagnosis in 559 cases were retrospectively an- alyzed. Positive and negative coincidence rate of CT were evaluated regarding central lymph node metastasis. The distribution of the central lymph node metastasis as cluster nodes, highly enhancement, the minimum diameter/maximum diameter≥1/2, cystic degeneration and microcalcification were observed. The appearance of Hashimoto＇s thyroiditis in clustered lymph node group was analysed. Results： In all 625 central lymph nodes, 218 were metastasis. The positive and negative coincidence rate of CT in diagnosing central lymph node metastasis were 59.2%（129/218） and 91.6%（373/407） respectively. The cluster nodes, highly enhancement, the minimum diameter/maximum diameter≥1/2, cystic degeneration were common in lymph node metasta- sis group. The sensitivity, specificity, positive predictive value and accuracy were 31.7%：93.5%： 71.1%：72.7%, 84.1%：66.7%： 86%：79%, 95.5%：44.4%：80.7：80.6%, 2.5%：100%：100%：67.2% respectively. After combining four CT signs together, the sensitiv- ity, specificity, positive predictive value and accuracy were 59.2%, 88.2%, 72.9% and 78.1%. Mieroealcifieation was only found in 2 central lymph node metasiasis groups. In 114 cluster nodes, 31 showed Hashimoto＇s thyroiditis, in which 22 were misdiagnosed as lymph node metastasis. Conclusion： CT is of great value in diagnosing central lymph node metastasis. The duster nodes, obvious enhancement, the minimum diameter/maximum diameter.≥1/2, cystic degeneration contribute to the diag- nosis of lymph node metastasis. Meanwhile, the central lymph node could be clustered in Hashimoto＇s thyroiditis, which calls for clinical attention in order to prevent from being misdiagnosed as metastasis.

关 键 词：癌 乳头状 甲状腺肿瘤 肿瘤转移 体层摄影术 螺旋计算机 

分 类 号：R736.1[医药卫生—肿瘤] R730.261[医药卫生—临床医学]