Napolitano Giuseppina, Romeo Antonio, Vallone Gianfranco, Rossi Michele, Cagini Luca, Antinolfi Gabriele, Vitale Mario, Brunese Luca, Genovese Eugenio
BMC Surg. 2013;13 Suppl 2(Suppl 2):S52. doi: 10.1186/1471-2482-13-S2-S52. Epub 2013 Oct 8.
Ultrasound is considered the best diagnostic method for the detection of metastatic cervical lymph nodes (LNs) in patients with papillary thyroid carcinoma (PTC). According to current guidelines, all patients undergoing thyroidectomy for malignancy should undergo preoperative neck ultrasound of the thyroid and central and lateral neck LNs, followed by fine needle aspiration of suspicious LNs. Cervical LN involvement determenes the extent of surgery. Complete surgical resection disease at the initial operation decreases likelihood of future surgery for recurrent disease and may impact survival. We use a new technique, B-flow imaging (BFI), recently used for evaluation of thyroid nodules, to estimate the presence of BFI twinkling signs (BFI-TS), within metastatic LNs in patients with PTC.
Between September 2006 and December 2012, 304 patients with known PTC were examined for preoperative sonographic evaluation with gray-scale US, color Doppler US and BFI. Only 157 with at least one metastatic LN were included in our study. All patients included underwent surgery, and the final diagnosis was based on the results of histologic examination of the resected specimens. The following LN characteristics were evaluated: LN shape, abnormal echogenicity, the absent of hilum, calcifications, cystic appearance, peripheral vascularization and the presence of BFI-TS.
A total of 767 LNs were analyzed. 329 out of 767 were metastatic, according to the histopathologic findings. BFI-TS, showed 99.5% specificity and 81,5% sensitivity. We detected BFI-TS in 6 metastatic LNs that were negative to the other conventional US features.
Our results indicate that the BFI-TS has a diagnostic accuracy higher than the other conventional sonographic signs. Our findings suggest that BFI can be helpful in the selection of suspicious neck LNs that should be examined at cytologic examination or open biopsy for accurate preoperative staging and individual therapy selection.
超声被认为是检测甲状腺乳头状癌（PTC）患者颈部转移性淋巴结（LNs）的最佳诊断方法。根据当前指南，所有因恶性肿瘤接受甲状腺切除术的患者均应在术前对甲状腺及颈部中央和侧方淋巴结进行超声检查，随后对可疑淋巴结进行细针穿刺抽吸。颈部淋巴结受累决定手术范围。初次手术时完全切除病灶可降低未来复发疾病手术的可能性，并可能影响生存率。我们使用一种最近用于评估甲状腺结节的新技术——B 流成像（BFI），来评估 PTC 患者转移性淋巴结内 BFI 闪烁征（BFI-TS）的存在情况。
2006 年 9 月至 2012 年 12 月期间，对 304 例已知 PTC 患者进行术前超声检查，包括灰阶超声、彩色多普勒超声和 BFI。我们的研究仅纳入了 157 例至少有一个转移性淋巴结的患者。所有纳入患者均接受了手术，最终诊断基于切除标本的组织学检查结果。评估了以下淋巴结特征：淋巴结形状、异常回声、门部缺失、钙化、囊性表现、周边血管化以及 BFI-TS 的存在情况。
共分析了 767 个淋巴结。根据组织病理学结果，767 个中有 329 个为转移性淋巴结。BFI-TS 的特异性为 99.5%，敏感性为 81.5%。我们在 6 个对其他传统超声特征呈阴性的转移性淋巴结中检测到了 BFI-TS。
我们的结果表明，BFI-TS 的诊断准确性高于其他传统超声征象。我们的研究结果表明，BFI 有助于选择可疑的颈部淋巴结，这些淋巴结应进行细胞学检查或开放活检，以进行准确的术前分期和个体化治疗选择。
