Alzahrani Ali S, Alsuhaibani Hamad, Salam Suzan Abdel, Al Sifri Saud N, Mohamed Gamal, Al Sobhi Saif, Sulaiman Othman, Akhtar Mohamed
Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Endocr Pract. 2005 May-Jun;11(3):165-71. doi: 10.4158/EP.11.3.165.
To conduct a prospective study of the diagnostic value of features of cervical lymph nodes (large size, central location, abnormal shape, cystic changes, calcifications, and loss of echogenic hilum), assessed by neck ultrasonography (US), in patients scheduled for surgical treatment of persistent or recurrent differentiated thyroid cancer.
We studied 152 US abnormalities in 42 patients (median age, 38.5 years) who had undergone one or more neck operations, with or without radioiodine therapy, but continued to have persistent or recurrent disease, which was confirmed by fine-needle aspiration. Another surgical procedure was planned for these patients. On the day of operation, patients underwent a detailed US neck examination by an experienced radiologist. US abnormalities were plotted on a standard diagram of the neck and given specific numbers to help track them during surgical intervention and histopathologic examinations. The US features were compared with the final histopathologic diagnosis.
Of 152 US abnormalities, 127 involved cervical lymph nodes and 25 involved other types of tissue. In univariate analysis, size, absent echogenic hilum, cystic changes, calcifications, and central location (medial to the sternomastoid muscle) of cervical lymph nodes were significantly associated with the presence of metastatic involvement. In multivariate analysis, only central location (odds ratio, 4.07; 95% confidence interval [CI], 1.64 to 10.10) and size (odds ratio, 5.14; 95% CI, 1.64 to 16.06) remained significant. The receiver operating characteristic curve for the size of lymph nodes showed a large area under the curve of 0.77 (95% CI, 0.68 to 0.85), and a size of 7.5 mm showed the highest sensitivity and specificity.
Size and central location of cervical lymph nodes assessed by US during follow-up of patients with differentiated thyroid cancer were the most important predictors of presence of metastatic disease.
对颈部超声（US）评估的颈部淋巴结特征（大尺寸、中央位置、异常形状、囊性改变、钙化及低回声门部消失）在计划接受持续性或复发性分化型甲状腺癌手术治疗患者中的诊断价值进行前瞻性研究。
我们研究了42例患者（中位年龄38.5岁）的152处超声异常，这些患者接受过一次或多次颈部手术，接受或未接受放射性碘治疗，但仍存在持续性或复发性疾病，经细针穿刺活检确诊。计划对这些患者进行另一次手术。手术当天，由经验丰富的放射科医生对患者进行详细的颈部超声检查。将超声异常标注在颈部标准示意图上，并赋予特定编号，以便在手术干预和组织病理学检查过程中进行追踪。将超声特征与最终的组织病理学诊断结果进行比较。
152处超声异常中，127处累及颈部淋巴结，25处累及其他类型组织。单因素分析中，颈部淋巴结的大小、低回声门部消失、囊性改变、钙化及中央位置（胸锁乳突肌内侧）与转移累及显著相关。多因素分析中，仅中央位置（比值比，4.07；95%置信区间[CI]，1.64至10.10）和大小（比值比，5.14；95%CI，1.64至16.06）仍具有显著性。淋巴结大小的受试者工作特征曲线下面积为0.77（95%CI，0.68至0.85），7.5mm的大小显示出最高的敏感性和特异性。
在分化型甲状腺癌患者随访期间，超声评估的颈部淋巴结大小和中央位置是转移疾病存在的最重要预测指标。
