FNA-Tg测定在细针穿刺诊断甲状腺癌术后侧颈区可疑肿大淋巴结中的应用价值  

The value of thyroglobulin measurement in fine-needle aspiration for diagnosis of suspicious lymph nodes in patients with thyroid carcinoma after thyroidectomy

作　　者：李强[1] 赵博文[1] 吕江红[1] 寿金朵[1] 徐海珊[1] 许立龙[1] 高力[2] 张慕蕊[3] 朱江[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院超声科,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

出　　处：《中华耳鼻咽喉头颈外科杂志》2016年第5期378-382,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金（81471664）

摘　　要：目的 评价超声引导下细针穿刺洗脱液中甲状腺球蛋白（FNA-Tg）测定在细针穿刺（FNA）诊断甲状腺乳头状癌（PTC）术后侧颈区可疑肿大淋巴结中的价值.方法 回顾性分析112例PTC术后患者的128枚侧颈区超声显示为可疑肿大的淋巴结,行FNA及FNA-Tg测定,以手术病理为金标准,对具有不同超声特征数下FNA、FNA-Tg联合FNA（简称联合法）诊断转移性淋巴结的价值进行比较.结果 FNA、联合法诊断转移性淋巴结的敏感度、特异度、准确率分别为67.5％、98.0％、79.7％;87.0％、100.0％、92.2％,两者比较在敏感度、准确率方面差异有统计学意义（χ^2 =8.319,P=0.004;χ^2 =8.275,P =0.004）.可疑肿大淋巴结具有1个超声特征时,FNA、联合法诊断转移性淋巴结的敏感度、特异度、准确率分别为38.1％、95.7％、68.2％;71.0％、100.0％、86.4％,两者比较在敏感度、准确率方面差异有统计学意义（χ^2=4.709,P=0.030;χ^2 =4.141,P=0.042）;具有2个超声特征时,FNA、联合法诊断转移性淋巴结的敏感度、特异度、准确率分别为55.0％、100.0％、73.5％;90.0％、100.0％、94.1％,两者比较在敏感度、准确率方面差异有统计学意义（χ^2=6.140,P=0.013;χ^2=5.314,P=0.021）;具有0个、3个、4个或5个超声特征时,两者对转移性淋巴结诊断价值的差异均无统计学意义（P＞0.05）.结论 联合法有助于PTC术后转移性淋巴结的诊断,当可疑肿大淋巴结具有1个或2个超声特征时,两者联合后提高了单独FNA诊断的敏感度及准确率,但对于具有0个或2个以上超声特征的淋巴结,联合FNA-Tg未明显提高单独FNA的诊断价值.Objective To investigate the value of thyroglobulin measurement in ultrasound guided fine-needle aspiration （FNA-Tg）for detecting neck node metastasis in patients with papillary thyroid carcinoma（PTC）after thyroidectomy.Methods A total of 128 suspicious metastatic lymph nodes in 112 patients were retrospectively analyzed.Postoperative pathologic results were taken as the gold standard.The values of FNA and FNA-Tg combined FNA in the diagnosis of metastatic lymph nodes were compared with different ultrasonic features.Results The sensitivity,specificity and accuracy of single FNA for the diagnosis of neck node metastasis were 67.5%,98.0% and 79.7% respectively,and those of FNA-Tg combined FNA were 87.0%,100.0% and 92.2% respectively.Compared with single FNA,the sensitivity and accuracy of FNA-Tg combined FNA were increased significantly（χ2 =8.319,P =0.004;χ2 =8.275,P =0.004）.When the ultrasonographic characteristics met any one of five indicators for neck node metastasis,the sensitivity,specificity and accuracy of single FNA for the diagnosis of neck node metastasis were 38.1%,95.7% and 68.2% respectively,and those of FNA-Tg combined FNA were 71.0%,100.0% and 86.4% respectively.Compared with single FNA,the sensitivity and accuracy of FNA-Tg combined FNA were increased significantly （χ2 =4.709,P =0.030;χ2 =4.141,P =0.042）.When the ultrasonographic characteristics met any two of five indicators for neck node metastasis,the sensitivity,specificity and accuracy of single FNA for the diagnosis of neck node metastasis were 55.0%,100.0% and 73.5% respectively,and those of FNA-Tg combined FNA were 90.0%,100.0% and 94.1% respectively.Compared with single FNA,the sensitivity and accuracy of FNA-Tg combined FNA were increased significantly（χ2 =6.140,P =0.013;χ2 =5.314,P =0.021）.The ultrasonographic characteristics met any three,four or five of five indicators or did not meet any of the indicators,there was no significant difference in the value of the diagnosis of metastatic lymph nodes between singl

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：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]