甲状腺癌颈部转移性与非转移性淋巴结的超声特征

摘要

目的：探讨甲状腺癌颈部转移性与非转移性淋巴结的超声特征区别，评价术前超声诊断甲状腺癌颈部淋巴结转移的临床价值。方法回顾性分析行颈部淋巴结清扫手术的63例甲状腺癌患者共计164枚淋巴结的临床资料，术前均行甲状腺及颈部淋巴结超声检查，应用灰阶超声评估淋巴结大小、形态、边界、边缘、晕圈、内部结构、内部回声、回声均质性、有无钙化，应用彩色多普勒超声记录血流分布及血流丰富程度，应用频谱多普勒超声测量收缩期最高流速（PSV）、搏动指数（PI）、阻力指数（RI）。术前超声诊断结果与术后病理结果进行比较。结果转移组与非转移组相比，纵横比≥1、有丰富血供、淋巴结内有微小钙化、RI较高者常见于转移组。转移性淋巴结以Ⅵ区、Ⅲ区、Ⅳ区分布为主，转移率分别为52.2%、43.5%、43.5%。超声诊断甲状腺癌颈部淋巴结转移的灵敏度为61.6%，特异度为92.3%。结论甲状腺癌颈部转移性淋巴结具有一定的超声特征，综合多个指标判断可提高超声对甲状腺癌颈部转移性淋巴结的检出率，更好地为临床治疗提供参考。%Objective To investigate the differences of sonographic features of cervical lymph node between metastatic and non-metastatic groups of thyroid carcinoma and evaluate the clinical value of preoperative ultrasound in diagnosing cervical lymph node metastasis of thyroid carcinoma.Methods Clinical data of 164 lymph nodes of 63 patients diagnosed with thyroid carcinoma was analyzed retrospectively. Cervical lymph nodes and thyroids of all the patients were examined with preoperative ultrasound. Various parameters including the sizes, shapes, borders, margins, halos, internal structures, internal echogenicity, echo homogeneity and calciifcations of lymph nodes were evaluated by gray scale sonography and other parameters including vascularization distribution and vascularization degree of lymph nodes were recorded with color Doppler ultrasound. Then the peak systolic velocity, pulsatility index and resistive index of lymph nodes were measured by pulsed Doppler ultrasound. The results were compared with those of postoperative pathology. Results The results showed that the number of patients with lymph nodes whose sizes were larger, aspect ratios were ≥1, blood supply and microcalciifcations were abundant.There are more high RI value cases in metastatic group compared with non-metastatic group. The metastatic lymph nodes were mainly located inⅥ region (52.2%),Ⅲ region (43.5%) andⅣ region (43.5%), respectively. The sensitivity and specificity of ultrasound in diagnosing cervical lymph node metastasis of thyroid carcinoma were 61.6% and 92.3%, respectively.ConclusionThe ultrasound features of metastatic cervical lymph nodes of patients with thyroid carcinoma were special, which indicated that the comprehensive judgment of multiple features will improve the diagnosis accuracy of cervical lymph node metastasis.