甲状腺乳头状癌颈部淋巴结转移影像学特征与病理结果对比分析

发布时间：2018-08-16 08:59

【摘要】：目的：甲状腺乳头状癌是甲状腺恶性肿瘤中最为常见的类型，约占的甲状腺癌的80%，具有较高淋巴结转移率。而淋巴结转移又是影响预后的重要因素之一，故术前对甲状腺癌患者颈部淋巴结的准确评估至关重要。甲状腺乳头状癌的转移淋巴结有一定的影像学特征，了解其影像表现，对提高诊断的准确率具有重要意义。本研究旨在探讨影像学检查对甲状腺乳头状癌颈部淋巴结转移的诊断价值。方法：回顾性分析河北医科大学第四医院耳鼻咽喉-头颈外科自2013年3月～2013年10月间79例患者的临床资料，其中66例为初次手术，13例为二次术后。79例患者中，有36例(38侧)颈部触诊及影像学检查均为阳性；37例(44侧)颈部触诊阴性，影像学检查为阳性；6例颈部触诊及影像学检查均为阴性，术后经病理证实有转移性淋巴结。本组资料术前均常规行超声学检查，24例同时行颈部平扫增强CT检查。根据甲状腺原发灶、颈部淋巴结术中快速冰冻病理结果，依据中国甲状腺结节和分化型甲状腺癌诊治指南中甲状腺切除及颈清扫适应症行相应术式，术后标本均送检病理，将术前影像学检查与术后病理结果进行回顾性对比分析。结果： 1转移性淋巴结的长径/短径(L/S)敏感度为82.2%、特异度为57.1%，准确率为74.2%；淋巴门结构消失敏感度为85.4%、特异度为72.2%，准确率为81.8%；淋巴结内出现点状钙化敏感度为91.6%、特异度为56.6%，准确率为75.7%；囊性变敏感度为92.8%、特异度为36.5%，准确率为48.4%。经χ2检验甲状腺乳头状癌颈部淋巴结转移组和非转移组之间上述声像学特征的差异均具有统计学意义(P＜0.05)。以具备L/S＜2、淋巴结内出现点状钙化、淋巴门结构消失、囊性变中两条及两条以上声像学特征作为可疑淋巴结转移的指标进行综合考虑，超声诊断甲状腺癌颈部淋巴结转移的敏感度为92.1%、特异度为60.7%、准确率为78.7%。上述指标均高于以单一声像学特征的诊断指标。 2术前经超声检查且术后经病理证实的初次手术患者转移性淋巴结在颈部各区域的分布为:Ⅱ区(50.9%)、Ⅲ区(71.7%)、Ⅳ区(67.9%)、Ⅴ(30.2%)、Ⅵ区(45.3%)。 3超声诊断甲状腺癌术后颈部淋巴结复发转移的二维声像学各特征的敏感度、特异度及准确率均低于初次手术患者。 424例同时行颈部平扫增强CT检查的患者中，，21例术后病理结果为转移性淋巴结，CT在诊断甲状腺乳头状癌颈部淋巴结转移的敏感度、特异度及准确率分别为100%、50%、87.5%。其影像学特征包括：细颗粒状、斑块状钙化；囊变坏死区；增强扫描时淋巴结边缘明显强化；与周围组织分界不清；气管食管沟淋巴结直径＞5mm。结论： 1超声对甲状腺乳头状癌颈部淋巴结转移的诊断有其特征性声像学表现：L/S＜2、淋巴门结构消失、点状钙化、囊性变,将上述多个特征综合分析，有助于提高诊断的准确率，对临床治疗决策的制定具有重要意义。 2超声对甲状腺癌术后颈部肿大淋巴结的诊断和鉴别诊断也具有重要价值，是甲状腺癌术后随访过程中重要的监测手段之一，对具有上述声像学特征的可疑淋巴结可行细针穿刺细胞学检查。 3CT检查影像学特征包括：细颗粒状、斑块状钙化；囊变坏死区；增强扫描时淋巴结边缘明显强化；与周围组织分界不清；气管食管沟淋巴结直径＞5mm。对确定甲状腺乳头状癌颈部淋巴结转移具有重要的意义，可以提高淋巴结转移诊断的敏感度，并精确定位，应列为常规检查。 4超声和CT检查联合检查，互为补充更有利于指导临床。
[Abstract]:Objective: Papillary thyroid carcinoma is the most common type of thyroid malignancy, accounting for about 80% of thyroid cancer, with a high rate of lymph node metastasis. Lymph node metastasis is one of the important factors affecting prognosis, so it is very important to accurately evaluate the cervical lymph nodes of thyroid cancer patients before operation. Lymph nodes have certain imaging features, and understanding their imaging manifestations is of great significance to improve the accuracy of diagnosis.
Methods: The clinical data of 79 cases of Otolaryngology Head and neck surgery in the Fourth Hospital of Hebei Medical University from March 2013 to October 2013 were retrospectively analyzed. 66 cases were primary operation and 13 cases were secondary operation. Of the 79 cases, 36 cases (38 sides) were positive in cervical palpation and imaging examination, 37 cases (44 sides) were negative in cervical palpation and imaging examination. Ultrasound examination was routinely performed before operation and enhanced CT examination was performed in 24 cases simultaneously. According to the pathological results of primary thyroid lesions, cervical lymph nodes were frozen rapidly during operation. The indications of thyroidectomy and neck dissection in the diagnostic and therapeutic guidelines for differentiated thyroid carcinoma were analyzed retrospectively.
Result:
The sensitivity, specificity and accuracy of lymph node metastasis were 82.2%, 57.1% and 74.2%, 85.4%, 72.2% and 81.8%, 91.6%, 56.6% and 75.7% respectively, and 92.8% and 3.8% respectively. _2 test showed that there were significant differences between the cervical lymph node metastasis group and non-metastasis group (P < 0.05).
The sensitivity, specificity and accuracy of ultrasonic diagnosis of cervical lymph node metastasis of thyroid carcinoma were 92.1%, 60.7% and 78.7% respectively. Diagnostic criteria for single sonographic features.
2 The distribution of metastatic lymph nodes in the cervical region of the patients with primary operation confirmed by ultrasonography before operation and pathology after operation were: region II (50.9%), region III (71.7%), region IV (67.9%), region V (30.2%) and region VI (45.3%).
The sensitivity, specificity and accuracy of two-dimensional ultrasonography in the diagnosis of cervical lymph node recurrence and metastasis after thyroidectomy were lower than those of primary operation.
Of the 424 patients who underwent cervical plain and enhanced CT, 21 had metastatic lymph nodes. The sensitivity, specificity and accuracy of CT in the diagnosis of cervical lymph node metastasis of papillary thyroid carcinoma were 100%, 50% and 87.5%, respectively. The margin of lymph nodes was significantly enhanced, and the surrounding tissues were not clearly defined. The diameter of tracheoesophageal groove lymph nodes was more than 5mm..
Conclusion:
1. Ultrasound has its characteristic sonographic features in the diagnosis of cervical lymph node metastasis of papillary thyroid carcinoma: L/S<2, the disappearance of lymphatic hilar structure, punctate calcification and cystic degeneration.
Ultrasonography is also of great value in the diagnosis and differential diagnosis of cervical enlarged lymph nodes after thyroidectomy. It is one of the important monitoring methods in the follow-up of thyroid cancer. Fine needle aspiration cytology is feasible for suspicious lymph nodes with the above sonographic characteristics.
The imaging features of 3CT include fine granular, plaque calcification, cystic degeneration and necrosis, marked enhancement of lymph node margin, unclear demarcation with surrounding tissues, and the diameter of tracheoesophageal groove lymph nodes > 5mm. It is of great significance for cervical lymph node metastasis of papillary thyroid carcinoma and can improve the diagnosis of lymph node metastasis. The sensitivity and accuracy of breakage should be classified as routine examination.
4 joint examination of ultrasound and CT examination is complementary to each other, which is more conducive to guiding clinical practice.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R736.1;R445.1

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