超声诊断对甲状腺乳头状腺癌中央区清扫的临床指导意义  

Clinical significance of ultrasonography in the diagnosis of central clearing of papillary thyroid carcinoma

作　　者：赵志军[1] 赵珍[1] 马金华[2] 景尚华[1] 

机构地区：[1]河北医科大学第四医院耳鼻咽喉科,石家庄050000 [2]沧州市中心医院耳鼻咽喉科

出　　处：《临床耳鼻咽喉头颈外科杂志》2015年第6期538-541,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨超声诊断对甲状腺乳头状腺癌(特别是甲状腺微小灶癌)是否行中央区淋巴结清扫的临床指导意义。方法:分析2012-09-2013-12期间在我科(同一术者、同一标准)进行甲状腺乳头状腺癌行中央区淋巴结清扫手术的临床资料121例,评价术前超声对甲状腺微小灶癌和非微小灶癌中央区淋巴结转移的诊断价值。结果:121例患者中甲状腺微小灶癌(原发病灶d≤1.0cm)62例,其颈中央区淋巴结超声诊断的准确率为74.2%(46/62),漏诊率为61.9%(13/21),误诊率为7.3%(3/41),灵敏度为38.1%(8/21)、特异度为92.7%(38/41),阳性预测值为72.7%(8/11),阴性预测值为74.5%(38/51),Kappa值为0.3485(<0.4),表示在PTMC中术前超声与术后病理诊断一致性较差;非微小灶癌(原发病灶d>1.0cm)患者59例,其术前超声中央区淋巴结诊断的准确率为55.9%(33/59),漏诊率为58.3%(21/36),误诊率为21.7%(5/23),灵敏度为41.7%(15/36),特异度为78.3%(18/23),阳性预测值75.0%(15/20),阴性预测值为46.2%(18/39),Kappa值为0.1757(<0.4),表示超声诊断与术后病理诊断一致性仍较差。结论:甲状腺微小灶癌术前中央区淋巴结超声诊断提示可疑阳性的,需常规行颈中央区淋巴结清扫。对于中央区淋巴结超声提示阴性的,可结合患者高危因素决定是否行预防性颈中央区淋巴结清扫。非微小灶型甲状腺乳头状腺癌中央区淋巴结超声检查无论是否提示有无异常淋巴结,均应行颈中央区淋巴结清扫。Objective：The purpose of this article is to discuss the clinical value of central neck lymph node dissection in papillary thyroid carcinoma,especially in thyroid papillary microcarcinoma（PTMC）.Also this article wants to evaluate the diagnostic significance of preoperative ultrasonography of central neck metastasis lymph nodes and the clinical significance of preoperative ultrasonography in central neck lymph node dissection.Method：Collected and analyzed 121 cases from September 2012 to December 2013.All of them had done the central neck lymph node dissection with the same standard by the same surgeon in our department.Evaluate the value of preoperative ultrasound diagnostic in thyroid microcarcinoma and non-microcarcinoma.Result：In the 121 patients,The 62 patients were diagnosed with PTMC（primary lesion d≤1.0cm）.Accuracy rate of ultrasound diagnostic was74.2%（46/62）,the rate of missed diagnosis was 61.9%（13/21）,the rate of misdiagnosis was 7.3 %（3/41）,sensitivity was 38.1%（8/21）,specificity was 92.7%（38/41）,positive predictive value was 72.7%（8/11）,negative predictive value was 74.5%（38/51）and the value of Kappa was 0.3485.The other 59 patients was diagnosed with thyroid papillary non-microcarcinoma（primary lesion d〉1.0cm）.The accuracy rate was 55.9%（33/59）,the rate of missed diagnosis was 58.3%（21/36）,the rate of misdiagnosis was 21.7%（5/23）,sensitivity was 41.7%（15/36）,specificity was 78.3%（18/23）,positive predictive value was 75.0%（15/20）,negative predictive value was 46.2%（18/39）and the value of Kappa was 0.1757.Conclusion：Cervical central lymph node dissection was necessary when the ultrasound diagnosis of cervical central lymph node-positive was prompted suspiciously in the thyroid papillary microcarcinoma.However,when it prompted negative,we could recommend patients to do the prophylactic central lymph node dissection in conjunction with the risk factors.Whether the ultrasound diagnosis of central lymph node was prompted suspic

关 键 词：甲状腺乳头状癌 甲状腺微小灶癌 颈淋巴结转移 中央区淋巴结清扫 颈部超声检查 

分 类 号：R736.1[医药卫生—肿瘤]