甲状腺乳头状癌伴颈部淋巴结转移的超声征象分析  

Study of ultrasonographic features in predicting reginal lymph node metastasis in patients with papillary thyroid carcinoma

作　　者：石文媛[1] 胡敏霞[1] 朱强[1] 夏春霞[1] 赵阳[1] 周亚静[1] 方亚琦[1] 荣雪余[1] 

机构地区：[1]首都医科大学附属北京同仁医院超声医学科,100730

出　　处：《中华医学杂志》2016年第27期2165-2168,共4页National Medical Journal of China

摘　　要：目的分析甲状腺乳头状癌（PTC）患者的超声征象与其颈部淋巴结转移的关系，拟发现某些特征，作为应该全面仔细或再次超声检查颈部淋巴结的警示指标。方法回顾性分析首都医科大学附属北京同仁医院2014年1至10月期136例甲状腺乳头状癌患者的一般资料和超声影像资料，按照淋巴结转移情况分为：转移组40例，其中男7例、女33例，年龄18—65岁，平均（39．6±10．3）岁；无转移组96例，男21例、女75例，年龄23—86岁，平均（47．7±12．8）岁。比较分析术后病理证实有无颈部淋巴结转移PTC患者的超声征象。结果本组136例共178枚结节，超声检出159枚（159／178，89．3％），未检出19枚（19／178，10．7％）。超声检出的159枚结节中，转移组40例51枚结节（40／136，29．4％），无转移组96例108枚结节（96／136，70．6％）。转移组平均年龄明显低于未转移组（P=0．0005），结节多发性高于单发性（P=0．0146）；超声征象多表现为边界不清晰（P=0．018）、实性（P=0．003）、含钙化（P=0．000）。颈部淋巴结转移中央区（Ⅵ区）占80％，单区分布占72．5％。结论患者年龄偏低，病灶呈多灶性，癌结节边界不清晰、实性、含钙化等，甲状腺乳头状癌提示伴发颈部淋巴结转移的风险增大。Objective To demonstrate the ultrasonographic features of papillary thyroid carcinoma （PTC） in predicting associated cervical lymph nodes metastasis （LNM）. Methods A total of 136 patients diagnosed with PTC in Beijing Tongren Hospital between January 2014 and September 2014 were enrolled. Of 136 cases, forty patients were confirmed with cervical lymph node metastasis. Seven were males, 33 were females, aged from 18 to 65 years old, mean age was （39. 6 ± 10. 3） years. The remaining 96 were reported without lymph node metastasis. Twenty-one were males, 75 were females, aged from 23 to 86 years old, mean age was （47.7 ± 12. 8） years. Medical record was reviewed for demographic characteristics and pathological findings. The ultrasonographic features of each case were evaluated retrospectively. The difference of ultrasonographic features between the patients with and without LNM was examined. Results There were 178 PTCs confirmed with pathology, 159 lesions （89.3%） were detected by ultrasonography, the remaining 19 lesions （ 10. 7% ） were under-detected. Of 136 patients with PTC, 40 cases （40/136,29.4%） were confirmed with cervical LNM, while the remaining 96 cases （96/136,70. 6% ） were determined without cervical LNM. PTC with cervical LNM was more frequently seen in the patients who were younger （P = 0. 000 5 ） and presenting with multifoeal tumors （ P = 0. 014 6 ）. Ultrasonographie features of PTC which significantly associated with LNM were ill-defined margins （ P = 0. 018 ） , solid appearance （ P = 0. 003 ） , and presence of calcification （ P = 0. 000 ）. Of 40 cases with LNM, central cervical LNM was seen in 32 cases （80%）, 72. 5% of whom appeared as unilateral distribution. Conclusions Patients diagnosed with PTC with younger age and identified with multiple foci of tumors at the time of diagnosis are in an increased risk of associated cervical LNM. Uhrasonographic features of ill-defined margins, solid appearance and calcification in PTC are significant

关 键 词：超声检查 癌 乳头状 淋巴转移 

分 类 号：R736.1[医药卫生—肿瘤] R445.1[医药卫生—临床医学]