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中华医学超声杂志(电子版) ›› 2019, Vol. 16 ›› Issue (09) : 647 -652. doi: 10.3877/cma.j.issn.1672-6448.2019.09.002

所属专题: 文献

浅表器官超声影像学

超声评估甲状腺乳头状癌不同分区转移性淋巴结的价值
陈易来1, 詹维伟1,(), 周伟1   
  1. 1. 200025 上海交通大学医学院附属瑞金医院超声科
  • 收稿日期:2018-11-20 出版日期:2019-09-01
  • 通信作者: 詹维伟

Value of ultrasound in evaluating metastatic lymph nodes in patients with papillary thyroid carcinoma

Yilai Chen1, Weiwei Zhan1,(), Wei Zhou1   

  1. 1. Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Received:2018-11-20 Published:2019-09-01
  • Corresponding author: Weiwei Zhan
  • About author:
    Corresponding author: Zhan Weiwei, Email:
引用本文:

陈易来, 詹维伟, 周伟. 超声评估甲状腺乳头状癌不同分区转移性淋巴结的价值[J/OL]. 中华医学超声杂志(电子版), 2019, 16(09): 647-652.

Yilai Chen, Weiwei Zhan, Wei Zhou. Value of ultrasound in evaluating metastatic lymph nodes in patients with papillary thyroid carcinoma[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(09): 647-652.

目的

探讨超声在评估甲状腺乳头状癌不同分区颈部转移性淋巴结中的价值。

方法

选取2016年3月至2018年6月在上海交通大学医学院附属瑞金医院就诊的213例甲状腺乳头状癌患者,共316枚颈部可疑淋巴结进行了术前超声诊断,以石蜡病理为"金标准",将淋巴结分为良性和恶性,根据淋巴结的位置将淋巴结分为中央区和颈侧区,分析了超声对不同分区淋巴结的诊断效能和不同分区淋巴结的超声特征。采用四格表计算转移性淋巴结的敏感度、特异度、阳性预测值、阴性预测值及诊断准确性。采用χ2检验和Fisher精确检验等方法比较不同分区转移性淋巴结的超声特点。中央区与颈侧区转移性淋巴结的大小采用秩和检验比较。

结果

213例患者均进行了中央区淋巴结清扫或中央区联合颈侧区淋巴结清扫。在纳入的161枚中央区淋巴结和155枚颈侧区淋巴结中,分别有102例(63.35%)和112例(72.26%)最终诊断为甲状腺乳头状癌转移性淋巴结。中央区和颈侧区转移性淋巴结的各超声征象:大小(Z=7.596)、形态趋圆(χ2=36.43)、钙化(χ2=10.59)、液化(χ2=8.89)、团状高回声(χ2=41.85)、淋巴门消失(χ2=11.13)及边缘或混合型血流信号(χ2 =51.55),差异均有统计学意义(P均<0.05)。在纳入的可疑超声征象中,淋巴门消失和团状高回声能较好的提示颈侧区淋巴结转移(χ2=18.559,P<0.05),然而,这些可疑超声征象对中央区转移性淋巴结都不具备足够的诊断效能。

结论

传统的可疑超声征象在中央区转移性淋巴结中诊断效能不足,超声评估中央区乳头状癌转移性淋巴结的准确性低于颈侧区。

Objective

To evaluate the value of ultrasound in diagnosing metastatic lymph nodes of different cervical compartments in patients with papillary thyroid carcinoma.

Methods

A total of 316 suspicious cervical lymph nodes from 213 papillary thyroid carcinoma patients diagnosed preoperatively by ultrasonography were evaluated in this study. The lymph nodes were divided into either a benign or malignant group according to pathology, and divided into either a central neck region group or a lateral neck region group according to the location of lymph nodes. The diagnostic efficacy of ultrasound and ultrasound features of cervical lymph nodes from different compartments were analyzed by the χ2 test and Fisher exact test.

Results

All the 213 patients underwent central lymph node dissection, alone or combined with lateral neck dissection. Among the 161 central lymph nodes, 102 (63.35%) were diagnosed as metastatic lymph nodes. Of 155 lateral neck lymph nodes, 112 (72.26%) were malignant. There were significant differences in ultrasound features including size, shape, internal echo, vascularity, and the presence of inner solid content or calcification between central and lateral neck lymph nodes (Z=7.596; χ2=36.43, 10.59, 8.89, 45.85, 11.13, 51.55; all P<0.05). The ultrasound characteristics of absence of echogenic hilum and hyperechogenicity in lateral lymph nodes indicated metastatic lymph nodes (χ2=18.559, P<0.05), but no ultrasound finding could predict metastatic lymph nodes in the central region.

Conclusion

Traditional ultrasonography features are insufficient in diagnosing metastatic lymph nodes in the central region, and the performance of ultrasound is lower in evaluation of central lymph nodes than lateral ones.

表1 316例甲状腺乳头状癌患者颈部中央区及外侧区可疑淋巴结的超声及病理诊断
表2 316例甲状腺乳头状癌患者颈部中央区和外侧区淋巴结转移的超声诊断效能(%)
表3 甲状腺乳头状癌患者颈部中央区和外侧区转移性淋巴结的超声征象比较
表4 比较甲状腺乳头状癌患者不同分区颈部淋巴结超声征象与良恶性关系[例(%)]
图1 患者,23岁,男性,右侧颈部Ⅱ区见可疑淋巴结(10 mm×32 mm),病理提示甲状腺乳头状癌转移(真阳性)。图a为灰阶图像纵切面,可见淋巴结呈椭圆形,淋巴门未见,淋巴结皮质局部呈高回声(实心箭头),另见片状无回声区(空心箭头所示);图b为彩色多普勒超声图像,可见淋巴结内部丰富混合型血流
图2 患者,51岁,女性,左侧颈部Ⅵ区淋巴结显示(3.3 mm×4.2 mm),病理提示甲状腺乳头状癌转移(假阴性)。图a为灰阶图像纵切面,可见淋巴结呈类圆形,淋巴门未见(箭头所示);图b为彩色多普勒超声图像,显示淋巴结内未见明显血流信号
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