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  

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

作　　者：张妮妮[1] 白宝艳[1] 王胜利[1] 袁泉[2] 李逢生[3] 

机构地区：[1]延安大学附属医院超声科,陕西延安716000 [2]延安大学附属医院普外科,陕西延安716000 [3]西安交通大学附属陕西省肿瘤医院超声科,陕西西安710061

出　　处：《现代肿瘤医学》2015年第21期3176-3178,共3页Journal of Modern Oncology

摘　　要：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(c N+)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。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 （eN ＋ ）in PTC who had undergone pre- operative 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 - circu- lar echoes and disappeared lymphatic hilum could be seen more frequently. The interior of nodes presented hypoechoic with calcification, cystic change or hypereehoic. Of 91 patients, number of bilateral cervical metastasis was 21 accoun- ted for 23.1%. Of 112 sides of cervical dissection specimens,89 sides belonged to multi - zone metastasis. The num- ber of cervical LNM accounted for 57.1% （ 64/112 ） in zone U , 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 statisti- cally（ 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 simuhaneously, which mainly distributed among zone Ⅱ , zone Ⅲ , zone IV and especially zone VI. The uhrasound of LNM presented quasi - circular echoes and disap- peared 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.

关 键 词：甲状腺乳头状癌 淋巴结转移 术前超声检查 

分 类 号：R730.261[医药卫生—肿瘤]