高频超声在分化型甲状腺癌淋巴结转移中的应用价值  

Application value of high-frequency ultrasound in lymph node metastasis of differentiated thyroid carcinoma

作　　者：周云 李萍[1] 陈松旺[1] 邵泽锋[2] 王国品[2] ZHOU Yun;LI Ping;CHEN Song-wang;SHAO Ze-feng;WANG Guo-pin(Department of Ultrasound,Nanjing First Hospital,Nanjing Medical University,Nanjing,Jiangsu 210006,China)

机构地区：[1]南京医科大学附属南京医院南京市第一医院超声科,江苏南京210006 [2]南京江北人民医院消化科,江苏南京210048

出　　处：《中国临床研究》2019年第11期1558-1560,共3页Chinese Journal of Clinical Research

基　　金：江苏省临床医学科技专项(BL2014013);南京市医学科技发展项目(YKK14087,YKK16266,YKK18242)~~

摘　　要：目的通过术前病灶的声像图特征和术中可疑淋巴结清扫病理结果进行对比,探讨高频超声在分化型甲状腺癌淋巴结转移中的应用价值。方法选取2014年1月至2018年5月病理诊断明确92例分化型甲状腺癌患者,均进行甲状腺切除+颈部淋巴结清扫。采用Esaote Mylab Twice型高频彩色多普勒诊断仪的高频探头进行颈部淋巴结探测,根据各项超声声像征象判断淋巴结是否转移,将超声判断结果与手术淋巴结清扫的病理结果进行对比。结果 92例患者超声检测出转移淋巴结49例,淋巴结未转移43例;术后病理检测转移淋巴结阳性53例,淋巴结未转移39例,颈部淋巴结转移率为53.3%。超声诊断准确度84.8%(78/92),敏感性83.0%(44/53),特异性87.2%(34/39),阳性预测值89.8%,阴性预测值79.1%。Kappa一致性检验显示术前超声和术后病理诊断转移淋巴结的区域和数量具有较好的一致性(Kappa=0.785,P=0.012)。结论高频超声检查能客观的评估淋巴结性质及分布范围,为分化型甲状腺癌临床手术方式的选择提供参考。Objective To explore the application value of high-frequency ultrasound in lymph node metastasis of differentiated thyroid cancer(DTC) by comparing preoperative sonographic features of lesions with pathological results of suspected lymph node dissection.Methods Ninety-two DTC patients conformed by pathology underwent thyroidectomy and cervical lymph node dissection.Before operation,the cervical lymph nodes were detected with high frequency probe of Esaote Mylab Twice high frequency color diagnostic apparatus,and the metastasis of lymph nodes was judged according to the ultrasonographic signs.The results of ultrasound in diagnosis were compared with the pathological results of lymph node dissection.Results There were 49 cases of metastatic lymph nodes and 43 cases of negative lymph nodes detected by ultrasound. Postoperative pathology revealed positive metastatic lymph nodes in 53 cases and negative lymph nodes in 39 cases,with a cervical lymph node metastasis rate of 53.3%.In ultrasound diagnosis,the accuracy,sensitivity,specificity,positive predictive value,negative predictive value were 84.8%(78/92),83.0%(44/53),87.2%(34/39),89.8%,79.1%,respectively.The Kappa consistency test showed a good consistency in the area and number of metastatic lymph nodes between preoperative ultrasound and postoperative pathology(Kappa=0.785,P=0.012).Conclusion High-frequency ultrasound can objectively evaluate the nature and distribution of lymph nodes and provide a reference for the selection of clinical operation methods for patients with DTC.

关 键 词：高频超声 甲状腺癌 淋巴结转移 敏感性 特异性 

分 类 号：R736.1[医药卫生—肿瘤]