细针抽吸洗脱液Tg检测在诊断甲状腺癌转移性淋巴结中的应用  

Application of fine needle aspiration assay of thyroglobulin eluent in the diagnosis of metastatic thyroid cancer lymph nodes

作　　者：赵美丽[1] 蒋翠萍 杨炜[1] 邵国强[2] ZHAO Meili;JIANG Cuiping;YANG Wei;SHAO Guoqiang(Department of Functional Examination,Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital),Nanjing 210006;Department of Nuclear Medicine,Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital),Nanjing 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)功能检查科,南京210006 [2]南京医科大学附属南京医院(南京市第一医院)核医学科,南京210006

出　　处：《临床与病理杂志》2021年第10期2267-2273,共7页Journal of Clinical and Pathological Research

基　　金：2019高层次卫生人才“六个一工程”拔尖人才项目基金(LGY2019005)。

摘　　要：目的:探讨超声引导下颈部淋巴结细针抽吸洗脱液甲状腺球蛋白(fine needle aspiration of thyroid globulin eluent,FNA-Tg)检测在诊断甲状腺癌转移性淋巴结中的价值及其影响因素。方法:选取可疑甲状腺癌颈部淋巴结转移患者78例(转移组56例,非转移组22例),术前行常规超声检查、超声引导下细针抽吸细胞学(ultrasound-guided fine needle aspiration cytology,US-FNAC)检测、FNATg检测,以术后病理为金标准计算US-FNAC及FNA-Tg各效能指标,得出FNA-Tg诊断界值;对比两组的超声特征;多因素二元logistic回归分析超声特征与FNA-Tg预测甲状腺癌转移性淋巴结的拟合度及影响,分析血清甲状腺球蛋白(thyroid globulin,Tg)及甲状腺存在状态对FNA-Tg诊断效能的影响。结果:US-FNAC及FNA-Tg(7.515 ng/mL为界值)诊断敏感度、特异度、阳性预测值、ROC曲线下面积分别为82.4%、90.9%、95.8%、0.865,100%、95.5%、100%、0.979。5项超声特征(淋巴结形态、内部高回声、液化、钙化、血流)差异有统计学意义(P<0.05),与FNA-Tg预测转移性淋巴结拟合度良好(符合率约92.3%),其中内部高回声及液化是FNA-Tg测值升高的独立危险因素。血清Tg测值及甲状腺存在状态均对FNA-Tg诊断效能无明显影响(P>0.05)。结论:FNA-Tg诊断甲状腺癌转移性淋巴结效能高于US-FNAC,与相关超声特征拟合度良好,且影响因素较少,但不能取代USFNAC,两者联合诊断效能更佳。Objective:To investigate the value and influencing factors of ultrasound-guided fine needle aspiration of thyroid globulin eluent(FNA-Tg)in the diagnosis of metastatic thyroid cancer lymph nodes.Methods:A total of 78 patients(56 cases of metastatic group,22 cases of non-metastatic group)with suspected cervical lymph node were selected.The routine ultrasound examination,ultrasound-guided fine needle aspiration cytology(US-FNAC)detection and FNA-Tg detection were performed before operation.The performance indexes of US-FNAC and FNA-Tg were calculated using postoperative pathology as the gold standard,and the threshold value of FNA-Tg was obtained,and the statistical differences of ultrasonic characteristics between the groups were compared.The fitting degree and influence between ultrasonic characteristics and FNA-Tg predicting metastatic thyroid cancer lymph nodes were analyzed by multivariate binary logistic regression,and the effects of serum thyroid globulin(Tg)and thyroid status on the diagnostic efficacy of FNA-Tg were analyzed.Results:The sensitivity,specificity,positive predictive value and the area under ROC curve of US-FNAC and FNA-Tg(with 7.515 ng/m L as the diagnostic threshold)were 82.4%,90.9%,95.8%,0.865;100%,95.5%,100%,0.979 respectively.There were statistically significant differences(P<0.05)in the five ultrasonographic features(lymph node morphology,internal hyperecho,liquefaction,calcification,and blood flow),which had a good fitting degree with FNA-Tg predicting metastatic lymph nodes(coincidence rate was about 92.3%).Among these features,internal hyperecho and liquefaction are independent risk factors for the increase of FNA-Tg values.Serum Tg measurements and thyroid status had no significant effect on the diagnostic efficacy of FNA-Tg(P>0.05).Conclusion:FNA-Tg is more effective than US-FNAC in the diagnosis of metastatic lymph nodes of thyroid cancer.It has a good fitting degree with related ultrasonic features and few influencing factors.However,US-FNAC cannot be replaced by FNA-Tg,and the co

关 键 词：甲状腺癌 颈部淋巴结 转移 甲状腺球蛋白 细针 

分 类 号：R736.1[医药卫生—肿瘤]