探讨甲状腺微小癌（TMC）颈部中央区肿大淋巴结（CLN）超声图像特征及临床诊断意义。

选取2014年1至12月在山西医科大学附属山西省肿瘤医院超声检查并经手术病理检查证实为TMC的患者422例，对颈部中央区肿大淋巴结的超声、术中检查及病理诊断结果进行对照，总结颈部中央区肿大淋巴结的超声表现。

422例TMC患者术前超声检出颈部中央区气管旁128例（30.3%，128/422）276个肿大淋巴结，其中多数淋巴结（98.6%，272/276）超声表现为低回声，长短径比≥2（63.8%，176/276），部分淋巴门结构不清（72.1%，199/276），血流稀少或无血流显示（91.7%，253/276）。术中清扫检出气管旁肿大淋巴结978个，其中522个（53.4%，522/978）淋巴结长径≤5.0 mm；术后病理检查证实100例（23.7%，100/422）203个气管旁淋巴结转移。术前超声未显示中央区气管前及喉前肿大淋巴结，术中清扫发现气管前和喉前肿大淋巴结51个（气管前22例48个肿大淋巴结，喉前3例3个肿大淋巴结）；其中30个淋巴结（58.8%，30/51）长径≤5.0 mm，5个（9.8%，5/51）淋巴结长径>10.0 mm；病理检查证实7例13个气管前淋巴结转移（1例气管前和喉前均显示1个淋巴结转移）。

TMC患者颈部中央区解剖结构复杂，且颈部中央区各亚区淋巴结所在位置较深、长径较小、术前超声检查极易漏检；术前超声未检出颈部肿大异常的淋巴结并不能排除微小淋巴结转移灶持续存在或复发的危险。了解甲状腺癌淋巴结转移规律、熟悉颈部中央区淋巴结转移的声像图特征，发现肿大淋巴结即扩大超声扫查范围，对颈部中央区各亚区仔细扫查，对指导临床手术彻底切除甲状腺癌及淋巴结转移灶有重要意义。

To evaluate the ultrasonographic features of enlarged central lymph nodes in thyroid microcarcinoma and its clinical significance.

The data of 422 cases of thyroid microcarcinoma in Shanxi Medical University Affiliated Tumor Hospital from January 2014 to December 2014 was investigated retrospectively. For the enlarged central lymph nodes, the results of ultrasonography, intraoperative detection and surgical pathology were compared, and the ultrasound characteristics of enlarged lymph nodes were assessed.

In 422 cases of thyroid microcarcinoma, 128 cases of central compartment lymphadenopathy were identified, including 276 nodes detected by preoperative ultrasound. The ultrasonic characteristics of central lymph nodes included hypo-echoic (98.6%, 272/276), L/T≥2 (63.8%, 176/276), absence of echogenic hilus (72.1%, 199/276), poor blood supply (91.7%, 253/276). Surgery detected 978 paratracheal lymph nodes, and 522 nodules were≤5.0 mm in diameter (53.4%). Among 422 patients, 100 cases with paratracheal lymph nodes were confirmed by pathology (23.7%). Preoperative ultrasound undetected pretracheal and prelaryngeal lymph nodes, and surgery detected 51 nodes, including 30 nodules≤5.0 mm in diameter (58.8%) and 5 nodules>10.0 mm in diameter (9.8%), of whom 7 cases with pretracheal and prelaryngeal lymph nodes were identified by pathology.

Preoperative ultrasound was prone to undetected, which may be involved with the deep location, the smaller diameter and complicated anatomy. The present findings emphasize that a negative US does not obviate the need for careful exploration of the central compartment to minimize the risk of persistent or recurrent local disease. The sonographer should be familiar with the status of central lymph node metastasis and ultrasonic features. The sonographer also should expand the area of the initiative while detect the central compartment lymphadenopathy, which is important guiding for surgical removal of thyroid cancer and lymph node metastasis.