CT检查中单发甲状腺乳头状癌同侧中央组淋巴结大小和分布的价值  

The value of lymph node size and distribution in ipsilateral central lymph node of single papillary thyroid carcinoma in CT examination

作　　者：韩志江[1] 赖旭峰 罗定存 丁金旺[2] Han Zhijiang;Lai Xufeng;Luo Dingcun;Ding Jinwang(Department of Radiology,Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine 310006,China;Department of Surgical Oncology,Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院放射科,310006 [2]浙江大学医学院附属杭州市第一人民医院肿瘤外科,310006

出　　处：《中华内分泌外科杂志》2019年第1期36-39,共4页Chinese Journal of Endocrine Surgery

基　　金：2013杭州市重大科技创新专项项目(20131813A08);2015浙江省医药卫生计划项目(2015KYB293);浙江省教育厅项目(Y201636958);浙江省公益技术应用研究项目(2017C33180);2018杭州市社会发展自主申报项目(20180533B39).

摘　　要：目的探讨CT检查中淋巴结大小和分布状态对单发PTC同侧中央组淋巴结转移(ipsilateral central lymph node metastasis,ICLNM)的诊断价值。方法回顾分析经手术及病理证实的278例直径>1.0cm单发PTC的CT资料,依据同侧中央组淋巴结直径将其分为<0.2cm组、0.2~0.4cm组和≥0.4cm组,统计ICLNM阳性和阴性在3组间和组内的分布差异,再依据淋巴结分布状态将0.2~0.4cm组分为浑浊组(≥3枚)和非浑浊组(1~2枚),将≥0.4cm组分为簇状组(≥3枚)和非簇状组(1~2枚),统计浑浊组和非浑浊组、簇状组和非簇状组间的差异。结果278例PTC中,病理证实ICLNM阳性和阴性比例分别为65.8%(183/278)和34.2%(95/278),<0.2cm组、0.2~0.4cm组和≥0.4cm组ICLNM阳性分别占37.3%(31/83)、68.0%(66/97)和87.8%(86/98),组间和组内χ^2和P值分别为51.082和0、16.956和0、49.955和0、11.022和0.001;浑浊组和非浑浊组ICLNM阳性分别占74.0%(57/77)和45%(9/20),χ^2和P值分别为6.151和0.013;簇状淋巴结组和非簇状淋巴结组ICLNM阳性分别占92.6%(50/54)和82%(36/44),χ^2和P分别为2.619和0.106。结论PTC患者的CT检查中,随着中央组淋巴结增多、直径增大,ICLNM阳性比例增加,对于0.2~0.4cm组病例,浑浊征象提示转移可能性更大,对这些征象的准确识别,有助于外科医生采取更彻底的手术治疗方案,对降低术后复发具有重要意义。Objective To investigate the diagnostic value of lymph node size and distribution in ipsilateral central lymph node metastasis(ICLNM)of single papillary thyroid carcinoma(PTC)in CT examination.Method The CT data of 278 single PTC with diameter > 1.0 cm confirmed by operation and pathology were retrospectively analyzed.According to the ipsilateral central lymph node diameter,these cases were divided into < 0.2 cm group,0.2-0.4 cm group and≥0.4 cm group,and the distribution difference of ICLNM positive and negative between the three groups were analyzed.Then according to the lymph node distribution,0.2 to 0.4 cm group were divided into turbidity group(≥3)and non-turbidity group(1-2),and≥0.4 cm group were divided into cluster group(≥3)and non-cluster group(1-2).The differences betweeen turbidity group and non-turbidity group,cluster group and non-cluster group were analyzed.Results In 278 PTC,the proportion of ICLNM positive and negative was 65.8%(183/278)and 34.2%(95/278),respectively.ICLNM positive in <0.2 cm group,0.2-0.4 cm group and≥0.4 cm group accounted for 37.3%(31/83),68%(66/97)and 87.8%(86/98),respectively.χ^2 value and P value in between groups and within groups were 51.082 and 0,16.956 and 0,49.955 and 0,11.022 and 0.001,respectively.ICLNM positive in turbidity group and non-turbidity group accounted for 74.0%(57/77)and 45%(9/20),respectively.χ^2 value and P value were 6.151 and 0.013,respectively.ICLNM positive in cluster group and and non-cluster group accounted for 92.6%(50/54)and 82%(36/44),respectively.χ^2 value and P value were 2.619 and 0.106,respectively.Conclusions Among CT examination of patients with PTC,with the increase of the diameter and number of lymph nodes in central group,the positive proportion of ICLNM positive increases.For the 0.2-0.4 cm group,the turbidity phenomenon suggests that the possibility of metastasis is greater.The accurate identification of these signs can help surgeons take a more thorough surgical treatment and have great significance to reduce postoperat

关 键 词：甲状腺肿瘤 甲状腺结节 中央组淋巴结 体层摄影术 X线计算机 

分 类 号：R730.44[医药卫生—肿瘤] R736.1[医药卫生—临床医学]