超声引导下FNAC联合FNA-Tg测定诊断甲状腺乳头状癌颈部淋巴结转移的临床价值  

Clinical value of ultrasound-guided FNAC combined with FNA-Tg measurement in the diagnosis of cervical lymph node metastasis of papillary thyroid carcinoma

作　　者：黄启灿 华梦颖 卢延嘉 高启 杨传坤 卞祥宇 李成龙 潘锐柯[5] 胡中倩[1] HUANG Qican;HUA Mengying;LU Yanjia;GAO Qi;YANG Chuankun;BIAN Xiangyu;LI Chenglong;PAN Ruike;HU Zhongqian(Department of Ultrasound Medicine,Zhongda Hospital,School of Medicine,Southeast University,Nanjing 210009,China;Department of Laboratory Medicine,Zhongda Hospital,School of Medicine,Southeast University,Nanjing 210009,China;Department of Epidemiology and Health Statistics,School of Public Health,Southeast University,Nanjing 210009,China;Department of Ultrasound Medicine,Nanjing Lishui District People’s Hospital,Nanjing 211200,China;Department of Ultrasound,the First People’s Hospital of Lianyungang,Lianyungang 222002,China)

机构地区：[1]东南大学医学院附属中大医院超声医学科,江苏南京210009 [2]东南大学医学院附属中大医院检验科,江苏南京210009 [3]东南大学公共卫生学院流行病与卫生统计学系,江苏南京210009 [4]南京市溧水区人民医院超声医学科,江苏南京211200 [5]江苏省连云港市第一人民医院超声科,江苏连云港222002

出　　处：《临床超声医学杂志》2025年第4期290-295,共6页Journal of Clinical Ultrasound in Medicine

基　　金：国家自然科学基金项目(81971628);东南大学附属中大医院江苏省高水平医院结对帮扶建设经费(zdlyg16)。

摘　　要：目的探讨超声引导下细针穿刺细胞学检查(FNAC)联合洗脱液甲状腺球蛋白(FNA-Tg)测定诊断甲状腺乳头状癌(PTC)患者颈部淋巴结转移的临床价值。方法选取我院PTC伴可疑颈部淋巴结转移患者70例(共71枚可疑淋巴结,术后病理诊断为转移性淋巴结40枚,非转移性淋巴结31枚),均行超声引导下FNAC和FNA-Tg测定。以术后病理结果为金标准,绘制受试者工作特征(ROC)曲线分析超声引导下FNAC、FNA-Tg测定及二者联合应用诊断PTC患者颈部淋巴结转移的效能;采用Kappa检验分析各方法诊断结果与病理结果的一致性。结果40枚PTC转移性淋巴结中,超声引导下FNAC漏诊12枚,超声引导下FNA-Tg测定漏诊2枚,二者联合应用漏诊1枚;31枚非转移性淋巴结中,超声引导下FNAC误诊1枚,超声引导下FNA-Tg测定均准确诊断,二者联合应用误诊1枚。ROC曲线分析显示,超声引导下FNAC、FNA-Tg测定及二者联合应用诊断PTC患者颈部淋巴结转移的曲线下面积(AUC)分别为0.834、0.993、0.971,灵敏度分别为70.0%、95.0%、97.5%,特异度分别97.0%、100%、97.0%,准确率分别为97.0%、100%、97.5%。超声引导下FNA-Tg测定及二者联合应用的AUC、灵敏度、准确率均明显高于超声引导下FNAC,差异均有统计学意义(均P<0.05)。一致性分析显示,超声引导下FNAC诊断结果与病理结果的一致性中等(Kappa=0.642,P<0.05),超声引导下FNA-Tg测定及二者联合应用诊断结果与病理结果的一致性均良好(均Kappa=0.943,均P<0.05)。结论超声引导下FNA-Tg测定诊断PTC患者颈部淋巴结转移的效能优于超声引导下FNAC,二者联合应用的诊断效能更佳。Objective To investigate the clinical values of ultrasound-guided fine-needle aspiration cytology(FNAC)combined with thyroglobulin washout(FNA-Tg)measurement in the diagnosis of cervical lymph node metastasis in papillary thyroid carcinoma(PTC)patients.Methods Seventy patients with PTC with suspected cervical lymph node metastasis in our hospital were selected totally 71 suspected lymph nodes,including 40 metastatic lymph nodes and 31 non-metastatic lymph nodes which confirmed by pathology after surgery.FNAC and FNA-Tg measurement were measured under ultrasonic guidance.Taking postoperative pathological results as the gold standard,receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of ultrasound-guided FNAC,FNA-Tg measurement and their combined application for cervical lymph node metastasis in PTC patients.Kappa test was used to analyze the consistency between the diagnostic results and pathological results.Results Among 40 PTC metastatic lymph nodes,12 were missed by ultrasound-guided FNAC,2 were missed by ultrasound-guided FNA-Tg measurement,and 1 was missed by the combination of the two methods.Among 31 non-metastatic lymph nodes,1 was misdiagnosed by ultrasound-guided FNAC,and ultrasound-guided FNA-Tg measurement was accurately diagnosed,and 1 was misdiagnosed by the combination of the two methods.ROC curve analysis showed that the area under the curve(AUC)of ultrasound-guided FNAC,FNA-Tg measurement and their combination in the diagnosis of cervical lymph node metastasis in PTC patients were 0.834,0.993 and 0.971,sensitivities were 70.0%,95.0%,97.5%,specificities were 97.0%,100%,97.0%,accuracies were 97.0%,100%,97.5%,respectively.The AUC,sensitivity and accuracy of ultrasound-guided FNA-Tg measurement and the combination were significantly higher than those of ultrasound-guided FNAC,with statistically significant differences(all P<0.05).The consistency analysis showed that the consistency between ultrasound-guided FNAC diagnostic results and pathological results was mode

关 键 词：超声引导 细针穿刺 球蛋白原位测定 甲状腺乳头状癌 淋巴结转移 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]