Wei Qiaoqiao, Wu Daozhu, Luo Hongxia, Wang Xiaohua, Zhang Rong, Liu Yongfang
Department of Ultrasonic Diagnosis, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China.
J BUON. 2018 Jul-Aug;23(4):1041-1048.
To investigate the characteristics of lymph node (LN) metastasis of papillary thyroid carcinoma (PTC) with ultrasonography (US) and spiral computed tomography (CT) and the significance of their combination in the diagnosis and prognosis of LN metastasis.
A total of 93 PTC patients admitted to and treated in the oncology department of our hospital were randomly enrolled in this study. LN imaging signs were explored by US, CT and their combination. Through the comparison with pathological findings, the diagnostic efficiency of three methods in LN metastasis in patients with PTC was analyzed. Postoperatively, all patients were followed up for 1-3 years to analyze the relationship between LN metastasis and the prognosis of PTC.
Among 93 PTC patients, 69 (74.19%) had LN metastasis, and 24 (25.81%) had not. US examination revealed that metastatic LN were hypoechoic and obviously calcified, and had aspect ratio >1 and strong blood flow signals. Among them, there were significant differences in calcification and blood flow between LN metastasis group and non-metastasis group (p<0.05). CT images indicated that metastatic LN were swollen, had low-density and were calcified with abundant blood flow signals. In addition, the edge, calcification and CT reinforced examination showed obvious differences between the LN metastasis group and the non-metastasis group (p<0.05). The sensitivity, specificity and accuracy of US alone in the diagnosis of LN metastasis were clearly better than those of CT alone (p<0.05), while their combination was better than both US and CT alone in the sensitivity, specificity and accuracy in the diagnosis of LN metastasis (p<0.05). Follow-up data suggested that the 3-year recurrence or metastasis rates of patients in the metastasis and non-metastasis groups were 4.54 and 11.27%, respectively, showing a statistically significant difference (p<0.05).
US combined with CT can make up for the deficiencies of each examination alone, and improve the sensitivity and specificity of PTC LN metastasis detection. It is worthy of clinical promotion.
探讨超声（US）及螺旋计算机断层扫描（CT）对甲状腺乳头状癌（PTC）淋巴结转移的特征及其联合应用在PTC淋巴结转移诊断及预后评估中的意义。
选取我院肿瘤科收治并治疗的93例PTC患者纳入本研究。通过US、CT及其联合检查探究淋巴结影像学特征。通过与病理结果对比，分析三种方法对PTC患者淋巴结转移的诊断效能。术后对所有患者进行1-3年随访，分析淋巴结转移与PTC预后的关系。
93例PTC患者中，69例（74.19%）发生淋巴结转移，24例（25.81%）未发生转移。US检查显示转移淋巴结呈低回声且有明显钙化，纵横比>1，血流信号丰富。其中，淋巴结转移组与未转移组在钙化及血流方面存在显著差异（p<0.05）。CT图像显示转移淋巴结肿大，呈低密度，有钙化，血流信号丰富。此外，淋巴结转移组与未转移组在淋巴结边缘、钙化及CT增强检查方面存在明显差异（p<0.05）。单独US诊断淋巴结转移的敏感度、特异度及准确度明显优于单独CT（p<0.05），而两者联合在诊断淋巴结转移的敏感度、特异度及准确度方面均优于单独US及单独CT（p<0.05）。随访数据表明，转移组与未转移组患者的3年复发或转移率分别为4.54%和11.27%，差异有统计学意义（p<0.05）。
US联合CT可弥补各自单独检查的不足，提高PTC淋巴结转移检测的敏感度及特异度，值得临床推广。
