超声联合细针穿刺洗脱液甲状腺球蛋白测定在甲状腺乳头状癌颈部淋巴结转移诊断中的应用  

Ultrasound combined with FNA-Tg in the diagnosis of cervical lymph node metastasis in papillary thyroid carcinoma

作　　者：陈瑞珠 张欢 郑立春[3] 刘丽云[4] 欧阳向柳 CHEN Ruizhu;ZHANG Huan;ZHENG Lichun;LIU Liyun;OUYANG Xiangliu(Department of Ultrasound,Tangshan Gongren Hospital,Tangshan 063000,China;Graduate School of North China University of Science and Technology,Tangshan 063000,China;Department of Nuclear Medicine,Tangshan Gongren Hospital,Tangshan 063000,China;Department of Pathology,Tangshan Gongren Hospital,Tangshan 063000,China)

机构地区：[1]唐山市工人医院超声医学科,河北唐山063000 [2]华北理工大学研究生学院,河北唐山063000 [3]唐山市工人医院核医学科,河北唐山063000 [4]唐山市工人医院病理科,河北唐山063000

出　　处：《中国医科大学学报》2024年第11期999-1004,1011,共7页Journal of China Medical University

基　　金：河北省医学科学研究课题计划(20201517);河北省医学科学研究课题计划(20231781)。

摘　　要：目的比较超声、细针穿刺洗脱液甲状腺球蛋白测定(FNA-Tg)及两者联合对甲状腺乳头状癌(PTC)颈部淋巴结转移的诊断价值。方法回顾性分析2017年1月至2023年3月唐山市工人医院130例PTC患者(共144枚淋巴结)的临床资料,依据颈部淋巴结病理结果分为转移组和非转移组,比较2组淋巴结超声特征表现,血清Tg、洗脱液Tg水平;利用受试者操作特征(ROC)曲线比较超声、FNA-Tg及二者联合对颈部淋巴结转移的诊断效能。结果144枚颈部淋巴结中,转移组64枚,非转移组80枚。与非转移组比较,转移组淋巴结皮髓质分界不清,回声不均,伴有囊性变、微钙化和异常血流,差异均有统计学意义(均P<0.05);而横纵比和边缘是否清楚方面2组比较差异无统计学意义(均P>0.05)。转移组、非转移组血清Tg分别为19.5(1.9~70.7)ng/mL、20.4(8.9~38.3)ng/mL,2组比较差异无统计学意义(P>0.05);转移组、非转移组洗脱液Tg分别为500.0(49.4~500.0)ng/mL、2.4(0.6~6.5)ng/mL,2组比较差异有统计学意义(P<0.05),FNA-Tg的最佳临界值为11.7 ng/mL。FNA-Tg诊断颈部淋巴结转移的特异度、准确性、阳性预测值最高,超声与FNA-Tg联合诊断颈部淋巴结转移的灵敏度和阴性预测值最高。结论PTC颈部转移淋巴结的超声表现为皮髓质分界不清,回声不均,伴有囊性变、微钙化及异常血流;FNA-Tg对PTC转移淋巴结具有较高的诊断效能。当超声怀疑PTC颈部淋巴结异常时,应进行FNA-Tg,二者联合应用可能提高PTC颈部淋巴结转移的诊断效能。Objective To compare the diagnostic value of ultrasound,thyroglobulin measurement in fine-needle aspiration biopsy(FNATg),and their combination in the diagnosis of cervical lymph node metastasis in papillary thyroid carcinoma(PTC).Methods The clinical data of 130 patients(144 lymph nodes in total)with PTC in Tangshan Gongren Hospital from January 2017 to March 2023 were retrospectively analyzed.Patients were divided into metastatic and non-metastatic groups according to the pathological findings of the cervical lymph nodes.The ultrasonic characteristics,serum Tg,and eluate Tg levels were compared between the two groups.The diagnostic efficacy of ultrasound,FNA-Tg,and the combination for cervical lymph node metastasis was assessed using the receiver operating characteristic(ROC)curve.Results Among 144 cervical lymph nodes,64 comprised the metastatic group and 80 comprised the non-metastatic group.Compared with the non-metastatic group,the lymph nodes in the metastatic group had indistinct cortical-medullary demarcation,uneven echogenicity,cystic changes,microcalcifications,and abnormal blood flow,and the differences were statistically significant(all P<0.05);however,there was no statistically significant difference between the two groups in transverse to longitudinal ratios and whether the margins were clear(all P>0.05).Serum Tg in the metastatic and non-metastatic groups was 19.5(1.9-70.7)ng/mL and 20.4(8.9-38.3)ng/mL,respectively,and the difference between the two groups was not statistically significant(P>0.05);eluate Tg in the metastatic and non-metastatic groups was 500.0(49.4-500.0)ng/mL and 2.4(0.6-6.5)ng/mL,and the difference between the two groups was statistically significant(P<0.05),with an optimal FNA-Tg critical value of 11.7 ng/mL.FNA-Tg diagnosed cervical lymph node metastasis with the highest specificity,accuracy,and positive predictive value,whereas the combination of ultrasound and FNA-Tg diagnosed cervical lymph node metastasis with the highest sensitivity and negative predictive value.Conclusio

关 键 词：甲状腺乳头状癌 淋巴结转移 超声检查 甲状腺球蛋白 

分 类 号：R445.1[医药卫生—影像医学与核医学]