Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Republic of Korea.
AJR Am J Roentgenol. 2010 Sep;195(3):W240-4. doi: 10.2214/AJR.09.3965.
The purpose of this study was to determine the diagnostic accuracy of CT for detecting extrathyroidal invasion of thyroid cancer to adjacent structures.
Eighty-four patients (19 men, 65 women; age range, 19-84 years; mean, 54.2 +/- 15.4 years) with 86 malignant tumors of the thyroid with extracapsular extension (37 T3, 49 T4) were retrospectively enrolled in this study. Two radiologists independently evaluated the CT findings of invasion of thyroid cancer into the trachea, esophagus, common carotid artery, internal jugular vein, and recurrent laryngeal nerve. These results were compared with the surgical and histopathologic findings.
The mean sensitivity, specificity, and accuracy of CT were as follows: 59.1%, 91.4%, and 83.2% for tracheal invasion; 28.6%, 96.2%, and 90.7% for esophageal invasion; 75.0%, 99.4%, and 98.8% for invasion of the common carotid artery; 33.3%, 98.8%, and 97.1% for invasion of the internal jugular vein; and 78.2%, 89.8%, and 85.5% for invasion to the recurrent laryngeal nerve. Interobserver agreement was moderate to good in the five categories of extrathyroidal invasion with a mean kappa value of 0.65 (range, 0.49-0.77).
Although the effectiveness is limited by low sensitivity, CT may be a valuable tool for evaluation of extrathyroidal invasion of thyroid cancer to adjacent structures.
本研究旨在确定 CT 检测甲状腺癌向毗邻结构外侵犯的诊断准确性。
本研究回顾性纳入 84 例（19 男，65 女；年龄 19-84 岁，平均 54.2±15.4 岁）86 例甲状腺恶性肿瘤伴外囊侵犯（37 例 T3，49 例 T4）患者。两位放射科医生分别评估了 CT 对甲状腺癌侵犯气管、食管、颈总动脉、颈内静脉和喉返神经的表现。将这些结果与手术和组织病理学结果进行比较。
CT 对气管、食管、颈总动脉、颈内静脉和喉返神经侵犯的平均敏感度、特异度和准确度如下：59.1%、91.4%和 83.2%；28.6%、96.2%和 90.7%；75.0%、99.4%和 98.8%；33.3%、98.8%和 97.1%；78.2%、89.8%和 85.5%。五种类型的甲状腺外侵犯的观察者间一致性为中度至良好，平均κ 值为 0.65（范围 0.49-0.77）。
尽管敏感性有限，但 CT 可能是评估甲状腺癌向毗邻结构外侵犯的一种有价值的工具。
