基于美国癌症联合委员会/国际抗癌联盟（AJCC/UICC）第六版TNM分类系统的甲状腺乳头状癌术前超声分期表现

Performance of preoperative sonographic staging of papillary thyroid carcinoma based on the sixth edition of the AJCC/UICC TNM classification system.

作者信息

Park Jeong Seon, Son Kyu-Ri, Na Dong Gyu, Kim Eunhee, Kim Sungjun

机构信息

Department of Radiology, Seoul National University Hospital, Seoul [corrected] Korea.

出版信息

AJR Am J Roentgenol. 2009 Jan;192(1):66-72. doi: 10.2214/AJR.07.3731.

DOI:10.2214/AJR.07.3731

PMID:19098181

Abstract

OBJECTIVE

The purpose of this prospective study was to evaluate the overall performance of sonography for staging papillary thyroid carcinoma.

SUBJECTS AND METHODS

Ninety-four consecutive patients with papillary thyroid carcinoma underwent preoperative sonography. Two experienced radiologists prospectively evaluated primary tumors (e.g., diameter, number, presence of extrathyroidal invasion) and cervical lymph nodes for metastasis. A 5-point scale grading capsular abutment was used to evaluate the possibility of extrathyroidal invasion. Lymph nodes were divided into central and lateral groups according to N staging requirements. The sonographic criteria for lymph node metastasis were an absent hilum, hyperechoic change, a round shape, calcification, cystic change, or an abnormal color Doppler pattern. Sonographic results were correlated with histopathologic findings.

RESULTS

One hundred twenty-seven cancers in the 94 patients were proven after surgery. Sonography accurately identified 75.9% (22/29) of patients with multifocal cancer and 83.3% (15/18) of patients with bilateral cancers. Using a cutoff value of 50% or more of the tumor abutting the thyroid capsule (grade 2), the sensitivity, specificity, and accuracy of sonography in predicting extrathyroidal invasion were 85.3%, 70.0%, and 74.5%, respectively, and the overall accuracy of sonography for T staging was 67.0% (63/94). One hundred forty-seven cervical lymph node levels were dissected. All six sonographic findings were significantly more frequent in metastatic lymph nodes in the lateral group. However, in the central group, only two criteria-calcification and abnormal Doppler pattern-were found to significantly predict the presence of metastasis. The overall accuracy of sonography for N staging was 71.3% (67/94).

CONCLUSION

Sonography is a feasible tool to use for the preoperative staging of papillary thyroid carcinoma.

摘要

目的

本前瞻性研究旨在评估超声对甲状腺乳头状癌进行分期的整体性能。

对象与方法

94例连续的甲状腺乳头状癌患者接受了术前超声检查。两名经验丰富的放射科医生前瞻性地评估了原发性肿瘤（如直径、数量、甲状腺外侵犯情况）以及颈部淋巴结有无转移。采用5分制的包膜毗邻分级来评估甲状腺外侵犯的可能性。根据N分期要求，将淋巴结分为中央组和侧方组。淋巴结转移的超声标准为门部消失、高回声改变、圆形、钙化、囊性改变或异常的彩色多普勒血流模式。超声检查结果与组织病理学结果相关。

结果

94例患者术后证实有127处癌灶。超声准确识别出75.9%（22/29）的多灶性癌患者以及83.3%（15/18）的双侧癌患者。以肿瘤与甲状腺包膜毗邻程度达50%及以上（2级）为界值，超声预测甲状腺外侵犯的敏感性、特异性和准确性分别为85.3%、70.0%和74.5%，超声对T分期的总体准确性为67.0%（63/94）。共清扫了147个颈部淋巴结区域。所有六项超声表现在侧方组转移淋巴结中均显著更常见。然而，在中央组中，仅钙化和异常多普勒血流模式这两项标准被发现可显著预测转移的存在。超声对N分期的总体准确性为71.3%（67/94）。