超声诊断对甲状腺乳头状腺癌中央区清扫的临床指导意义

发布时间：2019-07-14 10:42

【摘要】：目的:探讨超声诊断对甲状腺乳头状腺癌(特别是甲状腺微小灶癌)是否行中央区淋巴结清扫的临床指导意义。方法:分析2012-09-2013-12期间在我科(同一术者、同一标准)进行甲状腺乳头状腺癌行中央区淋巴结清扫手术的临床资料121例,评价术前超声对甲状腺微小灶癌和非微小灶癌中央区淋巴结转移的诊断价值。结果:121例患者中甲状腺微小灶癌(原发病灶d≤1.0cm)62例,其颈中央区淋巴结超声诊断的准确率为74.2%(46/62),漏诊率为61.9%(13/21),误诊率为7.3%(3/41),灵敏度为38.1%(8/21)、特异度为92.7%(38/41),阳性预测值为72.7%(8/11),阴性预测值为74.5%(38/51),Kappa值为0.3485(0.4),表示在PTMC中术前超声与术后病理诊断一致性较差;非微小灶癌(原发病灶d1.0cm)患者59例,其术前超声中央区淋巴结诊断的准确率为55.9%(33/59),漏诊率为58.3%(21/36),误诊率为21.7%(5/23),灵敏度为41.7%(15/36),特异度为78.3%(18/23),阳性预测值75.0%(15/20),阴性预测值为46.2%(18/39),Kappa值为0.1757(0.4),表示超声诊断与术后病理诊断一致性仍较差。结论:甲状腺微小灶癌术前中央区淋巴结超声诊断提示可疑阳性的,需常规行颈中央区淋巴结清扫。对于中央区淋巴结超声提示阴性的,可结合患者高危因素决定是否行预防性颈中央区淋巴结清扫。非微小灶型甲状腺乳头状腺癌中央区淋巴结超声检查无论是否提示有无异常淋巴结,均应行颈中央区淋巴结清扫。
[Abstract]:Objective: to investigate the clinical significance of ultrasonic diagnosis in thyroid papilla carcinoma (especially thyroid microfocal carcinoma). Methods: the clinical data of 121 cases of thyroid papilla carcinoma undergoing central lymph node dissection in our department during 2012 / 09 / 2013 / 12 were analyzed. The diagnostic value of preoperative ultrasound in the central lymph node metastasis of thyroid microfocal carcinoma and non-microfocal carcinoma was evaluated. Results: in 62 cases of thyroid microfocal carcinoma (primary lesion d 鈮，

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