Morita Shinya, Mizoguchi Kenji, Suzuki Masanobu, Iizuka Keiji
Department of Otolaryngology, Kushiro City General Hospital, 1-12 Shunkodai, Kushiro, Hokkaido, 085-0822, Japan.
World J Surg. 2010 Nov;34(11):2564-9. doi: 10.1007/s00268-010-0733-8.
The aim of this study was to evaluate the accuracy of [(18)F]-fluoro-2-deoxy-D: -glucose-positron emission tomography/computed tomography, ultrasonography, and enhanced computed tomography alone in the preoperative diagnosis of lymph node metastasis in patients with papillary thyroid carcinoma.
In a prospective study performed between January 2007 and December 2009, 74 patients with a diagnosis of papillary thyroid carcinoma confirmed by fine-needle aspiration biopsy were referred to our institution for surgery. Preoperative assessment of metastasis in the central and lateral cervical lymph nodes was done using [(18)F]-fluoro-2-deoxy-D: -glucose-positron emission tomography/computed tomography, ultrasonography, and enhanced computed tomography. The results for each level of cervical node assessed using these methods were correlated with the pathology reports after surgery. We determined the sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of the three methods for all levels of cervical lymph node.
There were no significant differences in the diagnostic results obtained by [(18)F]-fluoro-2-deoxy-D: -glucose-positron emission tomography/computed tomography and enhanced computed tomography. However, ultrasonography images gave significantly better results than either [(18)F]-fluoro-2-deoxy-D: -glucose-positron emission tomography/computed tomography or enhanced computed tomography alone in identifying metastases on the basis of the level of cervical lymph node. In addition, the overall diagnostic accuracy tended to be higher for the lateral compartment than for the central compartment.
Preoperative assessment by ultrasonography of metastases in the central and lateral cervical lymph nodes might be the best methodology for determining the extent of surgical resection required to remove metastatic lymph nodes adequately in patients with papillary thyroid carcinoma.
本研究旨在评估[（18）F]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描、超声检查以及单独的增强计算机断层扫描在术前诊断甲状腺乳头状癌患者淋巴结转移中的准确性。
在2007年1月至2009年12月进行的一项前瞻性研究中，74例经细针穿刺活检确诊为甲状腺乳头状癌的患者被转至我院接受手术。使用[（18）F]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描、超声检查以及增强计算机断层扫描对颈部中央和侧方淋巴结转移进行术前评估。使用这些方法评估的每个颈部淋巴结水平的结果与术后病理报告进行关联。我们确定了这三种方法对所有颈部淋巴结水平的敏感性、特异性、阳性和阴性预测值以及诊断准确性。
[（18）F]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描和增强计算机断层扫描获得的诊断结果无显著差异。然而，在根据颈部淋巴结水平识别转移方面，超声图像单独给出的结果明显优于[（18）F]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描或增强计算机断层扫描。此外，侧方区域的总体诊断准确性往往高于中央区域。
术前通过超声评估颈部中央和侧方淋巴结转移可能是确定甲状腺乳头状癌患者充分切除转移淋巴结所需手术切除范围的最佳方法。
