Rosário Pedro W, Tavares Wilson C, Borges Michelle A R, Santos Juan Bernard N, Calsolari Maria Regina
Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte.
Endocr Pract. 2014 Apr;20(4):293-8. doi: 10.4158/EP13307.OR.
The objective of the present study was to validate an ultrasound (US) classification of cervical lymph nodes (LNs) in patients with papillary thyroid cancer (PTC) after thyroidectomy and radioactive iodine (131I) ablation.
We performed a prospective study in which the patients were submitted to thyroidectomy and 131I ablation and then followed until neck US revealed LN(s) ≥5 mm. A total of 288 LNs from 112 patients with PTC were evaluated. Patient management was based on LN characteristics grouped according to the classification system studied here.
The presence of microcalcifications and/or cystic degeneration of cervical LNs were highly suggestive of a metastatic etiology (specificity of 99.4%). In contrast, the most sensitive finding for LNs affected by PTC was the absence of an echogenic hilum (sensitivity of 100%). In the absence of these findings (microcalcifications, cystic degeneration, echogenic hilum), a metastatic etiology was the most likely in the case of a round LN (specificity of 89%). The differentiation of a spindle-shaped LN without a visible hilum by Doppler analysis permitted us to dichotomize an initial probability of metastases of 13% in 25% (with peripheral vascularization) versus 3.3% (without peripheral vascularization).
Our results confirm that the classification proposed for cervical LNs in patients with PTC is valid for determining patient management following initial therapy.
本研究的目的是验证甲状腺乳头状癌（PTC）患者甲状腺切除术后及放射性碘（131I）消融后颈部淋巴结（LN）的超声（US）分类。
我们进行了一项前瞻性研究，患者接受甲状腺切除术和131I消融，然后进行随访，直至颈部超声显示淋巴结≥5mm。共评估了112例PTC患者的288个淋巴结。患者管理基于根据此处研究的分类系统分组的淋巴结特征。
颈部淋巴结存在微钙化和/或囊性变高度提示转移病因（特异性为99.4%）。相比之下，PTC累及淋巴结最敏感的表现是无高回声门（敏感性为100%）。在没有这些表现（微钙化、囊性变、高回声门）的情况下，圆形淋巴结最可能为转移病因（特异性为89%）。通过多普勒分析区分无可见门的梭形淋巴结，使我们能够将转移的初始概率分为25%时的13%（有外周血管化）和3.3%（无外周血管化）。
我们的结果证实，为PTC患者颈部淋巴结提出的分类对于确定初始治疗后的患者管理是有效的。
